Accidental ingestion of a press-through package: an underestimated cause of serious iatrogenic disease in the elderly?

Feasibility of Child-Resistant and Senior-Friendly Press-Through Packages: Potential of Different Materials

Press-through packaging (PTP) is the most common type of drug packaging in Japan, and a production procedure for PTP has been established at an acceptable cost. However, unknown problems and new needs with regard to safety among users of various age-groups still need to be examined. Considering accident reports involving children and older adults, the safety and quality of PTP and new forms of PTP, such as child-resistant and senior-friendly (CRSF) packaging, should be evaluated. We conducted an ergonomic study on children and older adults to compare types of commonly used PTP and new varieties of PTP. Opening tests were attempted by children and older adults using a common type of PTP (Type A) and child-resistant (CR) PTP (Types B1 and B2) made from soft aluminum foil. The same opening test was conducted on older patients with rheumatoid arthritis (RA). The results showed that CR PTP was difficult for children to open: only 1 out of 18 children could open Type B1. On the other hand, all eight of the older adults could open Type B1, and eight patients with RA could easily open Types B1 and B2. These findings suggest that the quality of CRSF PTP can be improved with the use of new materials.

Point-of-Care Ultrasound for an Esophageal Foreign Body

BACKGROUND

Press-through packs (PTPs) are widely used for storing drugs. The number of cases involving improper swallowing and esophageal foreign bodies (EFBs) has increased with the increasing use of PTPs. Studies have reported the utility of point-of-care ultrasound (POCUS) for evaluating EFBs. The application of POCUS for esophageal PTPs has not been reported.

CASE REPORT

An 83-year-old woman complaining of neck pain and odynophagia that occurred after improperly swallowing 2 PTPs was admitted to the emergency department. EFBs were suspected, and POCUS revealed a hyperechoic material, suggestive of a PTP, in the cervical esophagus. Endoscopy was immediately performed, and the PTPs were successfully removed without complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This study was significant because it documented the application of POCUS to detect esophageal PTPs. POCUS is a simple and noninvasive technique for identifying EFBs without radiation exposure. © 2022 Elsevier Inc.

Multidetector computed tomography to detect ingested press-through packages: utility of multiplanar reconstruction imaging in the emergency department

Case

We investigated the usefulness of multidetector computed tomography during examination in the emergency department to detect the location of press-through packages that had been inadvertently swallowed. In three patients, four press-through packages were detected on multi-planar reconstruction of multidetector computed tomography images, with three lodged in the esophagus and one in the stomach.

Outcome

The multidetector computed tomography detection rate of press-through packages was 100% in patients who realized they had swallowed the packages by mistake. After diagnosis, press-through packages in the esophagus were immediately removed endoscopically.

Conclusion

There are few reports on the usefulness of multi-planar reconstruction images by multidetector computed tomography during examinations in the emergency department for the diagnosis of foreign bodies in patients who have mistakenly swallowed press-through packages. Detecting the location of the packages provided useful information regarding the strategy for their removal. Therefore, proactive multidetector computed tomography use in the emergency department could be beneficial for patients who have inadvertently swallowed press-through packages.