Swallowers

We have a couple of swallowers who are frequenting our ED recently. One is in the inpatient psychiatric unit at our hospital. The other is in a closed psychiatric facility in the community. They both are very crazy and act out by swallowing anything and everything they can get a hold of. This usually leads to them coming to the ED for evaluation. Sometimes we just send them back to let the swallowed item pass. At other times we have to arrange to have someone go in after it, depending on what it is and how far down it got.

The lady in our hospital is under one-on-one observation. At her side at all times is a sitter whose job it is to keep her from swallowing anything. The other night, the patient leapt onto the sitter, pulled a pen out of her hand and gulped it down. Of course, they called and sent her to the ED for evaluation. I got an x-ray to see if had passed all the way into the stomach or if it was still in the esophagus.
The pen was mostly made of plastic, which doesn’t show up on x-ray. The only evidence of its presence was the little metal part at the tip that holds the ball in place. It was in her esophagus and showed that the pen had been swallowed back end first and was about half way down. I called the gastroenterologist and arranged for them to see her first thing in the morning.

I told the patient she was going back to her inpatient ward and she got really upset. As soon as I turned to go back to my paperwork, she leapt out of the gurney, bolted to the nursing IV cart, opened a drawer, grabbed two hands full of items out of the cart and was just about to get them to her mouth when she was stopped and restrained. She went back to psych hollering and screaming.