1. Esophagogastroduodenoscopy (EGD)

The best choice is EGD. This would allow identification and removal of the suspected food impaction. Papain has been used with mixed success for meat impactions but is probably not appropriate for initial therapy. He has no dyspnea or stridor and there is no indication for an emergency tracheostomy at this time.

His EGD reveals no food impaction or esophageal stricture. He does have diffuse gastritis without ulcers. However, his upper airway is noted to be narrowed and anesthesia is called for elective intubation. They successfully intubated the patient but their note says, “Difficult airway, even with Glidescope. Protect airway at all costs, unlikely to be able to intubate again.”

A neck CT scan is performed (Figure 1).

Figure 1. Representative lateral images from the neck CT scan.

What should be done next? (Click on the correct answer to proceed to the third of six pages)

  1. Administer antibiotics and corticosteroids
  2. Tracheostomy
  3. Laryngoscopy
  4. 1 and 3
  5. All of the above

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