# Button Battery Ingestion — GCMD Library living collection

Everything in the library about button battery ingestion — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 45 cited statements

## Episodes
### Surgical Management
- [QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088) — video · 8:10 · [machine version](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088.md)

### Evidence & Research
- [Journal of pediatric surgery Article Review: April 2023, IPEG issue](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959) — podcast · 13:22 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959.md)

### Case-Based Learning
- [Button Battery Ingestion](https://library.globalcastmd.com/watch/button-battery-ingestion-2300) — video · 14:28 · [machine version](https://library.globalcastmd.com/watch/button-battery-ingestion-2300.md)

## Chapters
- [0:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1) Case presentation and initial management of button battery ingestion (Ep 1)
- [2:33](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=153) Complications and follow-up management controversies (Ep 1)
- [4:41](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281) Epidemiology, pathophysiology, and vascular complications (Ep 1)
- [8:47](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527) Management of batteries in the stomach and esophageal injury assessment (Ep 1)
- [9:56](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596) Post-removal surveillance and management of identified injuries (Ep 1)
- [13:09](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=789) Emerging mitigation strategies and operational improvements (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=0) Introduction and podcast overview (Ep 2)
- [0:48](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=48) Titanic Index for pectus excavatum measurement (Ep 2)
- [4:43](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=283) Button battery ingestion risk factors (Ep 2)
- [7:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=473) Laparoscopic versus open choledochal cyst resection (Ep 2)
- [11:29](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=689) Summary and closing announcements (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=0) Introduction to Quad Conference and Topic Overview (Ep 3)
- [0:41](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=41) Button Battery Ingestion Epidemiology and High-Risk Criteria (Ep 3)
- [2:05](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=125) Complications and Sentinel Bleeds (Ep 3)
- [3:05](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=185) Decision Algorithm for Management (Ep 3)
- [4:10](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=250) Case Example: Aortic Pseudoaneurysm Repair (Ep 3)
- [4:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=283) Complex Airway Reconstruction and ECMO Use (Ep 3)
- [6:10](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=370) Caustic Ingestion Management (Ep 3)
- [7:09](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=429) Summary and Key Takeaways (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "A 1992 study reviewed more than 2000 cases of button battery ingestion in children and found no deaths." — Em Gootee (host_summary) [Ep 3 · 0:41](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=41)
- "Recent studies have found a sevenfold increase in fatalities following button battery ingestions." — Em Gootee (host_summary) [Ep 3 · 0:52](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=52)
- "The increase in fatalities is because of the change to a 20-volt lithium cell which causes coagulative necrosis." — Em Gootee (host_summary) [Ep 3 · 0:59](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=59)
- "There are 3 locations in the esophagus where button batteries tend to get stuck: the upper esophageal sphincter, behind the aortic arch, and at the lower esophageal sphincter." — Aaron Garrison (clinical) [Ep 3 · 1:06](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=66)
- "When a button battery sits in one of these positions, it causes transmural injury and will make a fistula between the esophagus and adjacent structures including trachea, blood vessels, or vocal cords." — Em Gootee (host_summary) [Ep 3 · 1:14](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=74)
- "High-risk criteria include younger patients with smaller esophagus." — Aaron Garrison (clinical) [Ep 3 · 1:33](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=93)
- "A larger battery over 20 millimeters or greater is riskier." — Em Gootee (host_summary) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=99)
- "Longer duration that the battery has been in the esophagus is associated with worse outcomes." — Aaron Garrison (clinical) [Ep 3 · 1:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=103)
- "A battery behind the aortic arch is more concerning." — Em Gootee (host_summary) [Ep 3 · 1:49](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=109)
- "If a patient has had a battery removed and presents later with a bleed, that is an emergency that needs to be taken seriously and requires a plan." — Aaron Garrison (clinical) [Ep 3 · 1:52](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=112)
- "In a Colorado study of 13 patients with high severity button battery injuries, 30% had esophageal perforation." — Em Gootee (host_summary) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=125)
- "In the Colorado study, 23% of patients developed stricture." — Em Gootee (host_summary) [Ep 3 · 2:14](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=134)
- "Some patients in the Colorado study required G-tube placement and stayed in the hospital for nearly 2 weeks." — Em Gootee (host_summary) [Ep 3 · 2:16](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=136)
- "Almost 25% of patients in the Colorado series died." — Aaron Garrison (epidemiological) [Ep 3 · 2:22](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=142)
- "Two of the fatalities in the Colorado series presented with the button batteries already in the stomach." — Aaron Garrison (epidemiological) [Ep 3 · 2:22](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=142)
- "Sentinel bleeds can be the first sign of aortoenteric fistulas." — Em Gootee (host_summary) [Ep 3 · 2:32](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=152)
- "Any small communication between the esophagus and the aorta can be potentially life-threatening." — Aaron Garrison (clinical) [Ep 3 · 2:41](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=161)
- "Some aortoesophageal fistulas showed up over 2 weeks after the batteries were removed." — Em Gootee (host_summary) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=170)
- "Aortoesophageal fistulas do not always happen in the hospital, so having a high index of suspicion and a plan for what to do once the battery is removed is helpful." — Aaron Garrison (clinical) [Ep 3 · 2:55](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=175)
- "For sick patients with esophageal foreign bodies and active bleeding or clinical instability, it is recommended to have GI surgery and CT surgery available for the procedure." — Aaron Garrison (guideline) [Ep 3 · 3:26](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=206)
- "Imaging beforehand with a CTA to assess inflammation and proximity to the aorta is helpful." — Em Gootee (host_summary) [Ep 3 · 3:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=219)
- "If imaging shows injury close to the aorta, continue NPO and antibiotics and repeat MRI in 5 to 7 days to assess the trajectory of inflammation." — Aaron Garrison (guideline) [Ep 3 · 3:47](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=227)
- "If there is any bleeding or concern for sentinel bleed, have a plan with interventional radiology, cardiology, or anyone who can help in that situation." — Em Gootee (host_summary) [Ep 3 · 3:59](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=239)
- "In one case report with a pseudoaneurysm from the arch of the aorta, repair was done with a staged approach: sternotomy on bypass to fix the aorta with a graft, followed by flap repair of the esophagus." — Em Gootee (host_summary) [Ep 3 · 4:10](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=250)
- "For high-risk patients (less than 5 years old, larger battery size), endoscopic evaluation of the esophagus is recommended because the duration of battery presence higher up than the stomach is unknown." — Aaron Garrison (guideline) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=270)
- "The need for ECMO or cardiopulmonary bypass depends on the location of the fistula and whether you can intubate past the injury enough to ventilate during the case." — Aaron Garrison (clinical) [Ep 3 · 4:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=283)
- "If the fistula is near the carina, complex airway reconstruction will be needed and adequate ventilation during the case will not be possible." — Aaron Garrison (clinical) [Ep 3 · 4:59](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=299)
- "In one case with a large tracheoesophageal fistula, the patient was placed on ECMO because they were unable to adequately ventilate." — Aaron Garrison (clinical) [Ep 3 · 5:21](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=321)
- "In the Cincinnati Children's case, an interposition graft was performed by removing a segment of trachea and using that trachea as the front wall of the esophagus." — Aaron Garrison (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=345)
- "Button batteries are ingested more than 3500 times per year in the United States." — Em Gootee (host_summary) [Ep 3 · 6:10](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=370)
- "Caustic ingestion is most common in young children between 1 and 3 years of age." — Em Gootee (host_summary) [Ep 3 · 6:20](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=380)
- "Most caustic ingestions by children are accidental and the amounts ingested tend to be small." — Em Gootee (host_summary) [Ep 3 · 6:25](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=385)
- "The airway may take priority in caustic ingestion cases, and patients can present in extremis or with an allergic-reaction-like presentation." — Aaron Garrison (clinical) [Ep 3 · 6:31](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=391)
- "Acidic substances that are spit back up rather than swallowed can cause severe injury to the epiglottis." — Em Gootee (host_summary) [Ep 3 · 6:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=403)
- "For esophageal perforation, the approach is to maintain the same exposure, debride to viable tissue, achieve layered closure with coverage, and if possible use a muscle flap for coverage." — Aaron Garrison (clinical) [Ep 3 · 6:56](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=416)
- "If the perforation is too big, drain it to allow for delayed repair." — Aaron Garrison (clinical) [Ep 3 · 7:09](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=429)
- "Smaller children, bigger batteries, and longer ingestion time pose greater risk." — Em Gootee (host_summary) [Ep 3 · 7:20](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=440)
- "Do not be reassured by a battery in the stomach, as injuries can progress even after battery removal." — Em Gootee (host_summary) [Ep 3 · 7:25](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=445)
- "Having an imaging plan to be proactive about finding transmural and worsening inflammation toward vessels is important." — Em Gootee (host_summary) [Ep 3 · 7:31](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=451)
- "For caustic ingestions, be patient; small perforations can heal and be managed conservatively." — Em Gootee (host_summary) [Ep 3 · 7:39](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=459)
- "If strictures develop after caustic ingestion, either dilation or surgery may be necessary." — Em Gootee (host_summary) [Ep 3 · 7:43](https://library.globalcastmd.com/watch/quad-4-surgical-management-of-button-battery-caustic-ingestion-with-dr-aaron-garrison-8088?t=463)
- "The Titanic Index measures the percentage of sternum that lies under the anterior costal line in pectus excavatum patients." — Luzia Toselli (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=120)
- "A Titanic Index cutoff of 66.5% predicts need for more than two bars with sensitivity of 93% and specificity of 92%." — Luzia Toselli (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=180)
- "The study included 78 pectus excavatum patients between 2020 and 2022, with 47% receiving two bars and 53% receiving more than two bars." — Luzia Toselli (epidemiological) [Ep 2 · 2:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=150)
- "The Titanic Index provides an objective way to determine bar number rather than guessing based on eyeballing or age." — Ellen Encisco (host_summary) [Ep 2 · 3:59](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=239)
- "Severe outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, or esophageal stricture development." — Ellen Encisco (host_summary) [Ep 2 · 5:36](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=336)
- "The Boston Children's study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes." — Ellen Encisco (host_summary) [Ep 2 · 6:05](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=365)
- "Three predictive factors for severe button battery outcomes are: battery in esophagus at presentation, battery size ≥2cm, and presence of any symptoms." — Ellen Encisco (host_summary) [Ep 2 · 6:20](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=380)
- "Time to button battery removal was not a significant predictor of severe outcomes in the Boston series." — Farokh Demeri (clinical) [Ep 2 · 7:24](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=444)
- "The national database study included 577 pediatric choledochal cyst patients aged 0-21 years from 2016 to 2018, with 28% undergoing laparoscopic and 72% open resection." — Chad Thorson (epidemiological) [Ep 2 · 8:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=534)
- "Most open choledochal cyst procedures were hepaticojejunostomy while most laparoscopic procedures were hepaticoduodenostomy." — Chad Thorson (clinical) [Ep 2 · 9:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- "Patients receiving open choledochal cyst operations had inferior outcomes including longer length of stay, higher cost, increased TPN use, and more central line requirements." — Chad Thorson (clinical) [Ep 2 · 9:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=567)
- "There was no significant difference in post-operative cholangitis or mortality between laparoscopic and open choledochal cyst resection despite different anastomosis types." — Mark Wulkan (host_summary) [Ep 2 · 10:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=632)
- "Laparoscopic biliary anastomosis for choledochal cysts has a learning curve and is not recommended for early career surgeons without assistance." (opinion) [Ep 2 · 10:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=654)
- "The Titanic Index is useful in clinical practice for preoperative planning of pectus excavatum repair." — Luzia Toselli (opinion) [Ep 2 · 4:25](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=265)
- "The risk score for button battery ingestion can help determine whether transfer to a specialized facility is needed." — Mark Wulkan (host_summary) [Ep 2 · 6:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-april-2023-ipeg-issue-6959?t=393)
- "Button battery ingestions are becoming more frequent, with national data showing increasing numbers of emergency department visits." — Dan (epidemiological) [Ep 1 · 0:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1)
- "Button batteries are ubiquitous in greeting cards, remotes, and similar devices." — Dan (clinical) [Ep 1 · 0:50](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=50)
- "A ring around the edge of a circular object on X-ray indicates it is a button battery, not a quarter." — Dan (clinical) [Ep 1 · 1:30](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=90)
- "Foley catheter technique may work for button battery removal when operating room access is delayed and symptom duration is short." — Dan (clinical) [Ep 1 · 2:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=130)
- "NASPGHAN and the GI group developed guidelines for button battery management with zero input from surgeons." — Mark (guideline) [Ep 1 · 3:44](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=224)
- "Guidelines mandate serial MRIs for button battery cases due to concern for vascular injury." — Mark (guideline) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=250)
- "The number of ED visits for button battery ingestion has doubled according to Colorado study data." — Dan (host_summary) [Ep 1 · 4:41](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281)
- "The rate of significant complications from button batteries has increased almost sevenfold." — Dan (host_summary) [Ep 1 · 5:00](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=300)
- "90% of serious outcomes occur with 20-25 millimeter batteries." — Dan (host_summary) [Ep 1 · 5:15](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=315)
- "20-25 millimeter batteries are lithium batteries that tend to be 3 volt rather than 1.5 volt." — Dan (clinical) [Ep 1 · 5:30](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=330)
- "The pathophysiology is caustic injury from hydroxide ions that rapidly raise tissue pH, not mechanical erosion or electricity." — Dan (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=345)
- "Complications include esophageal perforation, stricture, tracheoesophageal fistula, and vocal cord paralysis not associated with perforation." — Dan (clinical) [Ep 1 · 6:10](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=370)
- "Aortoenteric fistula is the most common cause of mortality in the national data bank, accounting for 46% of mortalities." — Dan (host_summary) [Ep 1 · 6:35](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=395)
- "Another 29% of mortalities involved some sort of vascular compromise." — Dan (host_summary) [Ep 1 · 7:00](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=420)
- "Aortoenteric fistula can occur up to 2 weeks post-removal of the battery." — Dan (host_summary) [Ep 1 · 7:15](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=435)
- "Authors of the Colorado paper recommend MRI after battery removal to assess potential impact on surrounding vasculature." — Dan (host_summary) [Ep 1 · 7:35](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=455)
- "Using trauma one system activation reduced time from door to OR from 1.5 hours to less than 30 minutes." (clinical) [Ep 1 · 8:47](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)
- "Some authors advocate scoping patients even when battery is in the stomach because patients can have significant esophageal injuries with the battery having passed on." — Dan (host_summary) [Ep 1 · 9:28](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=568)
- "Poison.gov recommendations say you do not need to scope if the battery is in the stomach." — Mark (host_summary) [Ep 1 · 9:56](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=596)
- "For minor mucosal injury on endoscopy, symptomatic follow-up without intervention is appropriate." — Dan (opinion) [Ep 1 · 10:24](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=624)
- "For circumferential erosions that look bad, re-scoping to look for stricture formation is recommended." — Dan (opinion) [Ep 1 · 10:43](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=643)
- "If patients become symptomatic after injury, esophagram can assess for narrowing or stricture." — Dan (clinical) [Ep 1 · 10:54](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=654)
- "Endoscopy advantage over esophagram is ability to reassess appearance and dilate if needed." — Dan (clinical) [Ep 1 · 11:32](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=692)
- "If already performing endoscopy and capable of removing battery from stomach, removal is advocated." — Dan (opinion) [Ep 1 · 12:27](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=747)
- "There is GI literature about removing 20 millimeter batteries from stomach because they may not pass the ileocecal valve." — Dan (host_summary) [Ep 1 · 12:50](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=770)
- "20-25 millimeter batteries are the ones of most concern." (clinical) [Ep 1 · 13:01](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=781)
- "There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize it." (clinical) [Ep 1 · 13:34](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=814)
- "Acetic acid for neutralization is not something off the shelf and requires pharmacy coordination." (clinical) [Ep 1 · 13:58](https://library.globalcastmd.com/watch/button-battery-ingestion-2300?t=838)

## Changelog
- Sep 17: 3 items added automatically

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