Podcast 653: Nitroglycerin Disimpaction

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Contributor: Ricky Dhaliwal, MD, JD

Educational Pearls:

  • Glucagon administered intravenously has a high rate of adverse events (nausea/vomiting) with very weak evidence
  • NItroglycerin too has very limited evidence but a much better adverse event profile
    • Mix 0.4 mg (1 sublingual tablet) nitro in 10 mL of water and administer orally
  • Nothing beats upper endoscopy for effectiveness but in settings where GI is not immediately available, nitroglycerin may be worth an attempt given its better safety profile to other medications

References

Arora S, Galich P. Myth: glucagon is an effective first-line therapy for esophageal foreign body impaction. CJEM 2015;11:169–71

Schimmel J, Slauson S. Swallowed Nitroglycerin to Treat Esophageal Food Impaction. Ann Emerg Med. 2019 Sep;74(3):462-463.

Summarized/Edited by Erik Verzemnieks, MD

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