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Interviewer: Is it bad enough to go to the emergency room, or isn't it? Find out now. This is "E.R. or Not?" on The Scope. Time for another episode of "E.R. or Not?" where you make the call of whether or not you should go to the E.R. and then we'll find out the definitive answer from Dr. Troy Madsen, emergency medicine at Ï㽶ÊÓƵ of Utah Hospital. Today's E.R. or not, a lot of people like to hang around with toothpicks hanging out of their mouth, old ranchers, truck drivers, what happens if you swallow a toothpick? E.R. or not?

Dr. Madsen: I would say E.R.

Interviewer: Really?

Dr. Madsen: And the reason for this is you can think of these sorts of things in two different categories, so we're talking about things that you accidentally swallow, in some cases I've seen where these things have been intentionally swallowed but that's kind of a different issue entirely.

Interviewer: Okay.

Dr. Madsen: But either these things are going to be too big to be able to pass through your intestines, or they're going to be sharp and potentially perforate the intestines.

Interviewer: Okay.

Dr. Madsen: Both of those are problems.

Interviewer: Okay.

Dr. Madsen: So if it's something that's too big and obviously that's not an issue with a toothpick, this isn't something that is really big, it should be able to pass without any issues, but the issue is that it's very sharp, so if we're talking about sharp things, and you know one of the big notorious things we see in kids that's very concerning is sewing needles, so kind of think of a toothpick like a sewing needle. Then you think of the intestines, once it gets past the stomach it's working it's way through and the intestines are very long and it's got a long way to travel, and they're very thin, so if it's something that's sharp it could potentially come up against the edge and push through that and perforate it.

Interviewer: Really.

Dr. Madsen: And the reason that's a problem is because you have all sorts of bacteria in the intestines. And the moment that bacteria gets into the abdomen itself, that can be a very serious thing and cause some very serious infections.

Interviewer: So now a lot of times after you chew on a toothpick for a long time they kind of start turning soft, that wouldn't in your stomach get soft and dissolve away?

Dr. Madsen: Yeah, and again it's a tough one. This is really . . . you gave me a tough one here. You really made me think about this because you're right. There are different scenarios where you may have kind of chewed on the toothpick and maybe bitten it and in that case it's probably kind of chewed up and kind of macerated where it's going to work it's way through without an issue, but if it's something where you've got a sharp object that is going to stay sharp, in your intestines and potentially perforate it, that's the problem. And so the reason I kind of say that is it's probably worth coming to the E.R., certainly if you're talking about a plastic sort of toothpick or even anything that's more firm, that's not going to dissolve easily.

Interviewer: Yeah, they have some of those new plastic toothpicks now and those could poke.

Dr. Madsen: Those definitely could and so I would say absolutely there. The wood one is a little bit more of a gray zone but I say come to the E.R. because it's worth evaluating and talking to our G.I. doctors, our specialists to see what their thoughts are on that.

Interviewer: Sure, because otherwise it could be serious.

Dr. Madsen: It could be and that's kind of weighing the risk benefit. It could potentially be a serious thing. If it's too long to pass, it's not going to go through, and the way we think of things that are too long or too wide, if it's longer than say about 5", this is a pencil you've swallowed and we have seen people who have swallowed pencils and they have been intentional-kind of interesting-that's not going to pass. And if it's wider than about 2", so it's something, maybe it's not 5" long but it's wider than 2", that's not going to pass, not going to get past the stomach.

Interviewer: What's the issue there then, if it gets stuck up in there?

Dr. Madsen: So if it gets stuck and it's right up there in the stomach, nothing's going to get through. So you're going to get to a point where you're drinking water and that might not even be able to work it's way around eventually. The bottom line there is it's not going out, so it has to be something that has to come out from above, so you have to get a G.I. doctor in to go down with a scope, pull that thing out and remove it from above.

Interviewer: Is that how a toothpick would be removed as well?

Dr. Madsen: It is.

Interviewer: So you don't have to get operated on, it's actually just removed through the throat?

Dr. Madsen: It is.

Interviewer: All right.

Dr. Madsen: Yeah, they're going to go down the esophagus and into the stomach, find it, pull it out.

Interviewer: If I swallowed something and it's blocking stuff up, what does that feel like then?

Dr. Madsen: All right. So if you swallow something, you can feel it. And a lot of people will come in and . . . kind of the thing we see there more is people more after they swallow a piece of meat without chewing it completely, you just feel a fullness in your throat and a lot of times people can point to exactly where it is. They can feel it upper throat, their lower throat or kind of down near the stomach, and often times they cannot swallow anything. They will just be sitting there with a cup spitting out their saliva, as they cannot actually swallow it. If they try to it just comes right back up.

Interviewer: What if it makes it to the stomach and it's blocking that?

Dr. Madsen: You're usually not going to have a lot of signs there until it's fairly progressed. So I would expect if it were blocking the stomach, you might not feel it. You're probably going to feel some discomfort in there but probably after you start to eat and if you've been eating a decent amount of food, you can just feel like it's just not moving anywhere, just like a rock in your stomach.

Interviewer: Would your body eventually throw up that food?

Dr. Madsen: Exactly. If you get enough in there, it's just going to build up and eventually it's just going to get full and it's just going to come right back up.

Interviewer: So rule of thumb, if you swallow something, width, length, what do I look out for?

Dr. Madsen: So in terms of width and length, think longer than about 5" or wider than about 2", and that's kind of just a general rule of thumb. And then if it's something that's sharp that could potentially cause a perforation in the intestines, that's concerning as well. And certainly with these, if you're not sure what to do, err on the side of caution, come to the emergency department and then we can help make appropriate decisions and get our specialist involved as well.

Interviewer: We're your daily dose of science, conversation and medicine. This is The Scope, Ï㽶ÊÓƵ of Utah Health Sciences Radio.