SOAP Note Questions for a 1-Year-8-Month-Old with Foreign Body Ingestion
The most important questions for a pediatric patient who has swallowed a toy should focus on assessing airway status, identifying the type of object ingested, and determining the time of ingestion to guide appropriate management. 1, 2
Subjective (History) Questions
Critical Information About the Ingestion:
- What exactly was swallowed? (Size, shape, material, sharp edges)
- When did the ingestion occur? (Exact time is crucial)
- Did anyone witness the ingestion? 1
- Is the child showing any signs of respiratory distress? (Coughing, gagging, stridor, wheezing)
- Is the child able to swallow normally? (Refusing food/liquids, drooling)
- Has the child vomited since the ingestion?
- Has there been any change in the child's behavior or activity level?
High-Risk Object Assessment:
- Is the object a battery, magnet, or sharp object? (These require urgent intervention) 3, 4
- What are the dimensions of the object? (Objects >2cm diameter may not pass the pylorus)
- Is the object made of metal? (Important for radiographic detection)
Medical History:
- Does the child have any pre-existing medical conditions?
- Has the child had previous foreign body ingestions?
- Any history of gastrointestinal disorders?
- Current medications?
Objective (Physical Examination) Questions
Vital Signs Assessment:
- What are the child's vital signs? (Heart rate, respiratory rate, temperature, oxygen saturation)
- Are there any abnormal vital signs for this age group? 2
Respiratory Assessment:
- Is there increased work of breathing? (Retractions, nasal flaring)
- Are breath sounds equal bilaterally?
- Is there stridor, wheezing, or abnormal breath sounds? 1
Abdominal Examination:
- Is there abdominal tenderness, distension, or guarding?
- Are bowel sounds normal?
- Any signs of peritonitis? (Especially important if ingestion occurred >24 hours ago) 5
ENT Examination:
- Is there evidence of oral/pharyngeal injury?
- Is there excessive drooling? (Suggests esophageal obstruction)
Assessment Questions
Diagnostic Studies:
- Has radiographic imaging been performed? (AP and lateral views)
- Is the object radiopaque or radiolucent?
- Where is the object located? (Esophagus, stomach, intestines)
- Are there signs of complications? (Free air, pneumomediastinum) 4
Risk Stratification:
- Is this a high-risk object requiring urgent intervention?
- Is there evidence of complete or partial airway obstruction? 1
- Are there signs of esophageal obstruction?
- Is there evidence of perforation or other complications? 3
Plan Questions
Immediate Management:
- Does this child require immediate airway intervention? 1
- Is endoscopic removal indicated? 6, 5
- Should the child be observed in the emergency department or admitted?
- Is surgical consultation necessary? 5
Follow-up Plan:
- What signs/symptoms should prompt return to the emergency department?
- When should follow-up imaging be obtained?
- What dietary modifications are needed? (NPO status vs. regular diet)
- What anticipatory guidance should be provided to parents? 1
Special Considerations
For Mild Foreign Body Airway Obstruction:
- Is the child able to cough effectively? (Allow them to clear airway by coughing while observing for worsening) 1
For Severe Foreign Body Airway Obstruction:
- Is the child unable to make sounds? (Requires immediate intervention with age-appropriate maneuvers) 1
- For this 1-year-8-month-old: Has back blows and chest thrusts been attempted? (Abdominal thrusts are appropriate for children >1 year) 1
Prevention Guidance:
- What toys are age-appropriate for this child?
- How can the home environment be made safer? 1
- What education do the parents need about choking hazards?
Remember that more than 90% of childhood deaths from foreign body aspiration occur in children under 5 years of age, making thorough assessment and appropriate management crucial in this age group 1.