Pocket Emergency Medicine (Pocket Notebook Series) 3rd Ed.

DIFFICULTY SWALLOWING

Definition

• Dysphagia is difficulty swallowing, odynophagia is pain w/ swallowing

Approach

• Nature: Time course, progressive (solids to liquids), localization (upper vs. lower esophagus)

• ROS, PMH, hx or FH of GI disorders or neurologic disorders

• Labs: CBC, BMP

• Studies: Barium swallow or EGD for structural/mechanical lesions; motility studies

Esophageal Food Impaction/Foreign Bodies

Definition

• Food or FB stuck in esophagus (70% lodge at the lower esophageal sphincter)

History

• Sensation of food (often meat) or FB stuck in the esophagus, retching, unable to swallow secretions, h/o esophageal stricture, scleroderma, or dysmotility

Physical Findings

• Respiratory distress (if at upper esophageal sphincter), drooling

Evaluation

• CXR (may show dilated esophagus w/ air–fluid level or FB)

Treatment

• Smooth muscle relaxants: Glucagon 2 mg IV (30–60% success rate), nitroglycerin SL, calcium channel blockers, benzodiazepines

• Endoscopy if medications as unsuccessful, if a dangerous object is present (batteries, sharp object), or FB doesn’t pass w/i 12–24 h

Disposition

• If tolerating PO, d/c w/ outpt EGD