2-23 ESOPHAGEAL FOOD BOLUS IMPACTION

Objective:

• To attempt to resolve a Food Bolus Impaction via esophageal smooth muscle relaxation.
• If glucagon administration is not successful at dislodging the Food Bolus, it will still expedite patient care by exhausting non-invasive management options.

Notes:

• This protocol should only be used for FOOD bolus impactions – DO NOT use for potentially rigid or sharp esophageal foreign bodies.
• An esophageal food bolus impaction is a bolus of food/non-liquid that was incompletely swallowed and is obstructing the esophagus, but is not compromising the airway.
• Glucagon is a smooth muscle relaxer, with between 10% - 40% effectiveness (depending on the study being quoted) at facilitating clearance of esophageal food bolus impactions.
• For patients < 18 years old, contact medical control for management recommendations.  

EMR/EMT - Emergency Medical Responder

1. Provide routine medical care as indicated.
2. Oxygen – High Flow, assist with ventilations as indicated.
3. Treat for signs and symptoms of respiratory distress as indicated.

EMT- Emergency Medical Technician  perform/confirm all above interventions

1. Assure ALS intercept is en route.
2. Apply ECG monitor & run strip (if trained, if time allows, and after all other interventions are completed).
3. Perform 12-lead ECG (if trained) as indicated.
4. Monitor for signs of respiratory distress.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate IV.
2. Administer NS fluid bolus, TKO (do not delay transport).

Intermediate/Paramedic  perform/confirm all above interventions

1. Once an IV is established, administer Zofran 4mg IV.
2. After IV Zofran is administered, then administer Glucagon 1mg IV.
   1. Record the exact time of Glucagon administration.
   2. Monitor for nausea/vomiting.
3. If still transporting 15 minutes after administration, can provide a trial of PO liquid to evaluate for bolus clearance and ability to swallow.
4. Ensure receiving facility is informed of the time of Glucagon administration.