Interviewer: All right, it's time to play the game ER or Not, where you get to play along and decide whether or not something that has happened is worth going to the emergency room. We're here with Dr. Troy Madsen, emergency room physician at University of Utah Hospital.
ER or Not? You're eating a chicken wing and you accidentally swallow a bone.
Dr. Madsen: This is tough one, Scot, so I want to know, what do you think?
Interviewer: All right, so I'm going to say that we did one on toothpicks before . . .
Dr. Madsen: Yes.
Interviewer: . . . that if you swallow a toothpick and it goes into your abdominal area it could puncture through.
Dr. Madsen: Sure.
Interviewer: I'm going to guess based on the kind of chicken wing or the chicken bone, that could be a problem here.
Dr. Madsen: Yes.
Interviewer: A bigger, duller bone, I don't know. It could be painful coming out, but it probably could pass through. I don't know. I don't know. I don't know.
Dr. Madsen: See? I'm going to put you to work in the ER. Look how much you've learned and how much you know. I'm so impressed. Those are the exact processes that are going on in my mind. I'm imagining myself having a family member call me and say, "I'm having chicken wings tonight. I was watching a game and I don't know what I did, but I swallowed a chicken bone."
Is the Bone in Your Throat or in Your Airway?
My first question for them is, "Are you sure you swallowed it? Are you sure it's not in your airway?" If it's in the airway, that's an entirely different issue. Absolutely, you need to get to the ER if it feels like it's stuck in there, you're having a hard time breathing, maybe there's like a high-pitch wheezing sound, that's ER, absolutely.
Interviewer: Anytime there's an airway issue, ER.
Dr. Madsen: Yes, ABC; A stands for airway. If it affects the airway, get to the ER.
Then the next question is, let's say, okay, it's not in the airway, what are we talking about in terms of a chicken bone here? I'm thinking number one, is it something that's going to somehow puncture their intestines as it's passing through? Was this a piece of a chicken bone that splintered, and then they swallowed it down? Or is it a really big chicken bone? And by a big chicken bone, I'm talking about something usually longer than about three inches.
Interviewer: Okay, so it would've been really hard to swallow something like that.
Dr. Madsen: It would have been, exactly. If you're talking about something three inches or longer, that's really tough to swallow, and a chicken wing isn't the sort of thing that's going to do that. If they tell me, you know, I don't know why they would do this but if somehow they were chewing on this chicken wing while watching a game and swallowed a big sharp piece down there, that would be a reason to go the ER because there you do worry about possibly causing some sort of a puncture wound in the stomach or in the intestines.
Or if they said, "This was not a chicken wing. This was a chicken thigh and this was a big bone," and again, I don't know why they would have done that or swallowed it, but that's another reason to go to the ER.
Interviewer: All right, so the grey area is a dull kind of bone that's not that big.
Dr. Madsen: Exactly.
Interviewer: Maybe a half-inch long, not very big around, is that going to pass through?
Dr. Madsen: It should, yeah.
Interviewer: Do you take the chance?
X-Ray in the ER
Dr. Madsen: If you're concerned you can always go to the ER. We can get an X-ray, we can look at it. It's a bone; we're going to see it on an x-ray. We can call the GI doctors and ask them to look at it. My suspicion is they would not go in and put you through anesthesia to go down and fish that out and pull it out. If it's a small chicken bone, maybe half an inch long, an inch long, it should pass through okay.
Interviewer: Okay. I'm nervous now. I mean, this is one of those things where in a couple of instances, you know absolutely what the answer is, but then there's that grey area.
Dr. Madsen: It is definitely a grey area.
Interviewer: Is there a chicken wing hotline I could call, like poison control that can give me some advice?
Dr. Madsen: It's funny, if you call poison control they probably would give you advice.
Interviewer: You think so?
Dr. Madsen: Yeah, they would. And then they would get people on the phone if they needed to. So of it is a grey area and you're not sure, and it's something you've ingested like that, they would probably be able to help you out there.
Interviewer: If it's the grey area, is there a period of time or something that would make you more concerned that this might be an issue?
Dr. Madsen: That's a tough one because some things, you swallow it and it's just going to sit there or it's going to work its way into your intestines. Once it gets in there, you may have no symptoms but it may be too far down to really fish it out. If it is a concern and you're just saying to yourself, "Hey, what do I do about this?" it's worth at least talking to someone, calling your doctor, and you can always go to the ER. It's not a big deal, but certainly talk to someone if you're just wondering, "What do I need to do about this?"
Interviewer: One of those nurse hotlines or something of that nature, perhaps.
Dr. Madsen: Exactly.
updated: July 22, 2020
originally published: April 3, 2016
