The “Olden Days” and the (o)esophagus

aka American ER Doc Gone Walkabout… 027 I got another “Pathway” to be used in our ED today – for the management of esophageal obstruction. It ought to be pretty useful, as it defines what the various departmental roles and responsibilities are if medical management fails – i.e. who manages sedation while GI disimpacts via endoscope and what happens next if endoscopy under procedural sedation only fails. But, I was surprised that the only recommended medical management was IV glucagon. I gave up on that decades ago – it’s never worked for me (except when the patient vomits from the glucagon, and blasts the food bolus out through his eyeballs – if you try this stuff, give it really slow), and in studies, it seems to generally be outperformed by placebo. Somewhere back in the early 70’s, I learned – and I don’t recall from whom or where – that GTN (glyceryl trinitrite, or NTG aka nitroglycerin for those in the upper half of the globe) worked well for lower esophageal food impactions. My impression over the years is that it does work – probably more than half the time – just standard 0.4 mg sublingual every 5 minutes for 3 doses or until symptoms resolve. I’ve used a glass of water as a chaser – partly, hoping that the weight of the water would encourage passage, but more as a diagnostic test – the patient can tell you if the water passes through the esophagus or not. These folks are often a bit volume dep...
Source: Life in the Fast Lane - Category: Emergency Medicine Doctors Authors: Tags: American ER Doc Gone Walkabout Emergency Medicine ENT and Maxillofacial Featured Gastroenterology esophageal obstruction flood bolus oesophagus rick abbott Source Type: blogs