A Swallowing Nightmare: Dealing with Food Bolus Obstruction in the ER

In this video, we talk about the causes, symptoms, diagnosis, and treatment of a food bolus obstruction from an emergency room perspective. A food bolus (AKA food bolus obstruction) occurs when food becomes lodged in the esophagus. A food bolus obstruction differs from choking, which happens when food blocks the airway so the patient cannot breathe.
The primary offender that causes a food bolus is usually meat, but it can also be things like vegetables.
The first cause of a food bolus is not chewing food well, eating too fast, or taking too big of bites. The second cause is a stricture or eosinophilic esophagitis, which is inflammation of the esophagus caused by allergies. The third cause is a mobility problem with the muscles in the esophagus. And the final cause is an esophageal spasm.
The symptoms of a food bolus obstruction include tightness or squeezing in the chest, neck or throat pain, pain with swallowing, increased salivation, and/or inability to eat anything else.
A food bolus can either go down to the stomach, come back up (vomiting), or get stuck in the esophagus.
Two complications can occur with a food bolus. Primarily, the patient can have breathing issues, which typically happen when the patient vomits and that vomit goes down the airway. Secondly, esophageal perforation can happen if parts of the food bolus poke holes in the esophagus.
Patients who are unable to clear the food bolus on their own, earn themselves a trip to the ER. In the ER, a good history and physical exam of the patient should be completed. We must ask patients about the type of food they were eating, any history of similar events, GERD, or esophageal/ peptic strictures. XRAYs of the neck and chest can be taken, but meat and even some animal bones may not show up easily.
For patients without complications, medical management is utilized. Glucagon, given IV, relaxes the smooth muscles in the esophagus and lower esophageal sphincter. Some providers attempt carbonated beverages, simethicone, and sodium bicarbonate, but the research on this method is mixed. If the above methods do not work, endoscopy should be done. Endoscopy is the procedure of putting a thin flexible tube with a light and camera down the patient’s throat and into the esophagus. Endoscopy can both fix and help diagnose the cause of a food bolus.

Resources:
https://www.ncbi.nlm.nih.gov/pmc/arti...
https://www.ncbi.nlm.nih.gov/pmc/arti...
https://entsho.com/food-bolus

Some Sound Effects taken from Epidemic Sound:
https://www.epidemicsound.com/track/o...
https://www.epidemicsound.com/track/6...


**Disclaimer: This is NOT clinical practice or medical advice. It is for information only. Errors may occur and practices may change. Please consult a physician or licensed independent practitioner (LIP) for medical/ health advice. Consult the latest literature and hospital/ organization policy prior to practicing. If you feel like you are having a medical emergency, please seek immediate medical attention/ go to the hospital. **