Patient swallowed bur nightmare scenario

[nobodylikesyourloudmusic]

Hi

Basically patient 2 days ago swallowed a bur from a handpiece during an implant abutment adjustment. We sent her to an urgent care to get a chest x-ray and it turned out negative. Somehow she ended up being transferred to the local hospital ER and has been there since. I went there directly on day 2 to visit the patient and found out that she is being starved and only given IV fluids just in case she turns into a surgery procedure. I spoke with the GI doctor and was informed that the bur is going through the GI tract as expected and that she does not need to be a surgery case. She only needs to take one more x-ray to see the bur in the rectal passage and she can be dismissed. I thought that was excessive but whatever. Today is day 3 and I just found out hat she is STILL being kept in the hospital for whatever reason. Can anybody help make sense of what is going on here? I thought for these situations you send the patient home if they didn't aspirate and assume that they'll just pass through the stool.

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[FutureDent020]

That’s really odd but out of your hands. I had a buddy who went through the same thing. He was sued and settled using his malpractice insurance. Just I’d to cover hospital expenses and patient’s loss of work income. He’s super successful and it’s didn’t affect his career at all. Just bad luck. No clue why they are keeping the patient in the hospital. You’ll be ok, but I’d be ready for litigation.

 

[Faefly]

Yeah that's what we learned that if it's not in the lungs or airways, they go home. Sorry for you and your patient to go through this!
Hope everything will be alright and they don't sue!

 

[Saddleshoes]

No rubber Dam?

 

[FutureDent020]

No rubber Dam?

They said implant abutment adjustment. Not sure how you’d use a dam there. But regardless, it’s a mistake and they’ll have to settle if litigation.

 

[Saddleshoes]

They said implant abutment adjustment. Not sure how you’d use a dam there. But regardless, it’s a mistake and they’ll have to settle if litigation.

Thanks!
Once again I wasn't paying attention to details!

 

[Faefly]

They said implant abutment adjustment. Not sure how you’d use a dam there. But regardless, it’s a mistake and they’ll have to settle if litigation.

How to make sure to avoid such a mistake?
For me, I am not doing implants, but I like to make sure to use the highspeed on the side to make sure it works and the bur is seated correctly because I had once tried it on the pt mouth and there you go the bur wasn't seated correctly and it was such a scary moment but my pt caught it in time. From that exprience I learned to not trust the bur is fully seated unless I tried it outside the mouth on the tray ( away from me, assistant or the pt)
Another thing is using gauze if it's like implant crown, or extraction, and I tie the floss on the screw driver and I seat the pt 45 degrees if I am delivering implant crown, etc.
Our program doesn't use rubber dam unless it's endo, we use Suctionisolate, this also a double edge sword, because it can suction the bur, but you'll be looking for it, thinking the pt swallow it. Last time, it suctioned a cord, well I learned to turned it off if I am packing a cord, but yeah.. I wonder if there are other tricks to avoid such incidents.

 

[nade0016]

Different scenario here but true. Pros at my institution had a patient swallow an hand implant driver. Fairly large item, with throat pack in place, it happens. Went to ED, Radiograph shows object in stomach. Sent home, return 7 days later for follow up radiograph. Driver still in stomach and then has GI scope and remove driver. My guess the hospital is just making sure everything passes. For those not in medicine. A 're-admit' as I described will probably not be paid by insurance so the hospital may be on the hook for this procedure. Just speculating but that could be the reason to the delay.

 

[princeafrica]

One of the dental clinics I externed at during dental school had a doc whose patient swallowed a bur. Was sent to the ED and had to stay there until the bur passes. They told him they said there were concerns it may damage GI tract as it passes and wanted to monitor (?)

 

[Life of Pablo]

OMS resident - in med school we learn anything sharp you’re either supposed to go and retrieve it or take serial X-rays (which is sounds like they’re doing if they’re monitoring it) to ensure it passes. There’s always a chance it perfs the bowel and causes bigger issues (peritonitis), which might be why they kept the patient there. If it was in the lungs, they wouldve immediately retrieved and sent the patient home.

 

[dante72]

How to make sure to avoid such a mistake?
For me, I am not doing implants, but I like to make sure to use the highspeed on the side to make sure it works and the bur is seated correctly because I had once tried it on the pt mouth and there you go the bur wasn't seated correctly and it was such a scary moment but my pt caught it in time. From that exprience I learned to not trust the bur is fully seated unless I tried it outside the mouth on the tray ( away from me, assistant or the pt)
Another thing is using gauze if it's like implant crown, or extraction, and I tie the floss on the screw driver and I seat the pt 45 degrees if I am delivering implant crown, etc.
Our program doesn't use rubber dam unless it's endo, we use Suctionisolate, this also a double edge sword, because it can suction the bur, but you'll be looking for it, thinking the pt swallow it. Last time, it suctioned a cord, well I learned to turned it off if I am packing a cord, but yeah.. I wonder if there are other tricks to avoid such incidents.

This is so true, I have OCD myself and always try the bur outside of the patient mouth aiming it to the wall.
One time (I have checked the bur is seated perfectly though) I pushed the pedal, and the bur which was a rough knife edge fly and went and hit the wall. It nicked the wall and I was like if it was the patient, would it consider as a headshot or sth else?
Turns out that handpiece had a problem which when it was working it would loosen the grip on the bur, we throw it out.
Always try the bur outside of patient mouth.

 

[Faefly]

This is so true, I have OCD myself and always try the bur outside of the patient mouth aiming it to the wall.
One time (I have checked the bur is seated perfectly though) I pushed the pedal, and the bur which was a rough knife edge fly and went and hit the wall. It nicked the wall and I was like if it was the patient, would it consider as a headshot or sth else?
Turns out that handpiece had a problem which when it was working it would loosen the grip on the bur, we throw it out.
Always try the bur outside of patient mouth.

Wow, so glad you tried it near the wall first.

 

[dante72]

Wow, so glad you tried it near the wall first.

I was so lucky, one point to OCD