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A middle-aged, edentulous black male arrives in the emergency room complaining of retrosternal pain just after swallowing a large piece of meat. A barium swallow roentgenogram confirms an obstruction in the distal esophagus. The endoscopist will not be available for an hour.
As the man becomes more uncomfortable, your best course of management is to
A. wait and observe closely
B. consult a thoracic surgeon
C. initiate blind instrumentation with a Fogarty catheter
D. administer proteolytic enzymes (papain, trypsin, chymotrypsin)
E. administer intravenous glucagon
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wait and obseve closely -- never thought of it
but in real life i will inform the thoracic surgeon
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Just A make sense to me, although not satisfied.
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A.makes more sense than the rest. What will a thoracic surgeon do? thoracotomy? IV glucagon and the rest will not help anything.
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alibi give some some queastions please--otherwise this forum is a time loss.
thanks--the exam is just nearby and there is so much to go.
i will be ever grateful
questions neednot be tough -it may be easy one also --but it could teach us a key point
thanks in advance
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djyoti,
You will do great on the test, dont be nervous! May I suggest you to look into some of the questions on step3 forum? They are indistinguishable from step 2 questions.
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yes alibi , you are right --why inform thoracic surgeon--they canot prevent perforation-they can repair after perforation
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Here is what the source says and I think you will enjoy it!
The administration of intravenous glucagon is the safest and most effective means of relieving esophageal food impaction when direct esophagoscopy is not available. Immediate action can be taken, eliminating the need to wait and observe. Glucagon acts within one to three minutes by reducing lower esophageal sphincter pressure, allowing the food bolus to pass. Side effects (hypersensitivity, nausea) are rare, and contraindications (pheochromocytoma, insulinoma) are few. Blind instrumentation has a low success rate and a high risk of perforation. Oral protease enzymes work slowly and may actually induce esophageal perforation via their digestive action as the duration of obstruction increases.
