Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dysphagia
- non-specific abdominal pain
- stridor and wheezing
- drooling
Other diagnostic factors
- gagging, nausea/vomiting, neck/throat pain
- atypical chest pain or non-cardiac chest pain
- choking
- signs of upper gastrointestinal obstruction
- lower gastrointestinal bleeding
- odynophagia
- fever, poor feeding, failure to thrive, and irritability (in children)
- acute or chronic asthma-like symptoms or recurrent pneumonia
- signs of sepsis
- sign of acute drug intoxication
Risk factors
- age <15 years
- male sex (adults)
- gastrointestinal tract narrowing
- mechanical disorders of the gastrointestinal tract
- chemical dependence
- intellectual disability
- mental illness
- inmates or people engaged in criminal activities
- dental disorders
- hurried eating
- impaired gag reflex
- history of underlying oesophageal disease, surgery, or procedure
- seizure disorder
Diagnostic investigations
1st investigations to order
- x-rays of neck, chest, abdomen
- FBC
- urea and electrolytes
- prothrombin time/INR
- PTT
- oxygen saturation
- faecal occult blood testing
- hand-held metal detector
Investigations to consider
- cardiac biomarkers
- ECG
- CT of neck, chest, and/or abdomen
- MRI
- laryngoscopy
- endoscopy
Treatment algorithm
Contributors
Authors VIEW ALL
Associate Professor
Department of Emergency Medicine
GW School of Medicine & Health Sciences
Center for Healthcare Innovation and Policy Research
Washington
DC
Disclosures
ACM declares that he has no competing interests.
Dr Andrew C. Meltzer would like to gratefully acknowledge Dr Juan Carlos Munoz and Professor Luis F. Laos, previous contributors to this topic.
Peer reviewers VIEW ALL
Consultant
Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies
TU Teaching Hospital
Maharajgunj
Kathmandu
Nepal
Disclosures
PA declares that he has no competing interests.
General Surgery Chief Resident
Department of General Surgery
University of Tennessee Medical Center
Knoxville
TN
Disclosures
JFA declares that he has no competing interests.
Clinical Research Fellow
Cleveland Clinic Florida
Weston
FL
Disclosures
RVS declares that he has no competing interests.
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
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