I can’t swallow it!!

lump-in-throat2

In keeping with the Christmas season of all things food-related – what do you use for oesophageal food bolus impaction in ED? Maybe Coca-Cola™ or buscopan or what about IV glucagon? Do any of these really work or should your patient be on the next endoscopy list? A recent EMJ Best Bet examines the evidence for intravenous glucagon in the treatment of oesophageal food bolus obstruction (FBO)

 

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Research says  – not enough high quality evidence to support the routine use of IV glucagon in oesophageal FBO BUT

Clinical bottom line:

  • Glucagon IV may be reasonable to use in FBO – it may not work if there is an underlying oesophageal structural abnormality
  • It may be successful in about 1/3 patients or it may not work at all in which case endoscopy is recommended
  • Less likely to work if meat is the obstructing agent
  • Optimal dose is 0.5mg IV, higher doses are no more effective and may cause unwanted side effects such as vomiting
  • In an older patient with a meat FBO, consider gastroscopy early

Author’s opinion – give it a go (in certain patients) but realise that it may not work and have a back up plan ready

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