Podcast 653: Nitroglycerin Disimpaction

<p><strong>Contributor:  Ricky Dhaliwal, MD, JD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Glucagon administered intravenously has a high rate of adverse events (nausea/vomiting) with very weak evidence</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">NItroglycerin too has very limited evidence but a much better adverse event profile</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Mix 0.4 mg (1 sublingual tablet) nitro in 10 mL of water and administer orally</span></li> </ul> </li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">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</span></li> </ul> <p><strong>References </strong></p> <p><span style="font-weight: 400; font-size: 10pt;">Arora S, Galich P. Myth: glucagon is an effective first-line therapy for esophageal foreign body impaction. CJEM 2015;11:169–71</span></p> <p><span style="font-weight: 400; font-size: 10pt;">Schimmel J, Slauson S. Swallowed Nitroglycerin to Treat Esophageal Food Impaction. Ann Emerg Med. 2019 Sep;74(3):462-463. </span></p> <p><span style="font-size: 10pt;"><em><span style= "font-weight: 400;">Summarized/Edited by Erik Verzemnieks, MD</span></em></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">The Emergency Medical Minute is excited to announce that we are now offering</span> <em><span style= "font-weight: 400;">AMA PRA Category 1 credits™</span></em> <span style="font-weight: 400;">via online course modules. To access these and for more information, visit our website at</span> <a href= "http://www.emergencymedicalminute.com/cme-courses"><span style= "font-weight: 400;">www.emergencymedicalminute.com/cme-cour