Stabilization and immediate precautions
›Airway and aspiration precautions
›NPO for high risk presentations
›Upright positioning
›Suction setup for drooling
›Analgesia and symptom control
›Acetaminophen 1000 mg PO once
›Hydromorphone IV 0.5 mg once for severe pain
›Time critical pathways
›If airway concern, ENT and anesthesia early
›If suspected perforation, CT chest with contrast and surgery consult
›Non critical pathways
›If progressive dysphagia without instability, urgent GI referral for EGD planning
›If stroke suspected, stroke protocol with neuroimaging
Targeted therapies by suspected etiology
›Deep neck space infection suspected
›Ampicillin sulbactam IV 3 g every 6 hours
›If MRSA risk, add vancomycin IV 15 mg per kg every 12 hours
›Dexamethasone IV 10 mg once for significant airway edema local protocol dependent
›Epiglottitis suspected
›Ceftriaxone IV 2 g daily
›If MRSA risk, add vancomycin IV 15 mg per kg every 12 hours
›Avoid agitation provoking interventions until airway plan in place
›Candida esophagitis suspected
›Fluconazole 400 mg PO or IV once
›Then fluconazole 200 mg to 400 mg daily for 14 to 21 days
›HSV esophagitis suspected
›Acyclovir 400 mg PO five times daily
›If severe or unable PO, acyclovir IV 5 mg per kg every 8 hours
›CMV esophagitis suspected
›Ganciclovir IV 5 mg per kg every 12 hours
›Specialist consultation recommended
›Pill induced esophagitis suspected
›Stop offending agent if possible
›PPI therapy example pantoprazole 40 mg PO daily
›Food bolus impaction suspected and stable airway
›Glucagon IV 1 mg once local protocol dependent
›GI consult for endoscopic removal when persistent obstruction
Monitoring and reassessment loop
›Reassessment timing
›Repeat airway assessment every 15 to 30 minutes if borderline
›Repeat vitals after analgesia and fluids
›Deterioration triggers
›New stridor or increased drooling
›Rising oxygen requirement
›New fever or hypotension