›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
17Disposition/dispo20
ICU criteria
›ICU level indications
›Airway compromise or impending obstruction
›Sepsis with vasopressor requirement
›Esophageal perforation with shock
Inpatient admission criteria
›Admission indications
›Unable to tolerate oral intake with dehydration
›Deep neck space infection
›Immunocompromised with suspected infectious esophagitis and poor intake
Observation pathway criteria
›Observation appropriate
›Partial dysphagia tolerating liquids with stable vitals
›Symptom control achieved and urgent outpatient testing arranged
Discharge criteria
›Discharge appropriate
›Stable airway and no drooling
›Tolerating oral fluids
›No concern for perforation or deep neck infection
›Follow up plan reliable
Follow up timing
›Follow up targets
›GI follow up within 72 hours to 2 weeks depending on severity
›ENT follow up within 24 to 72 hours if persistent throat symptoms
›SLP referral for oropharyngeal dysphagia when stable
18Discharge Instructions/di26
Copy discharge instructions
›Summary
›You were seen for trouble swallowing or pain with swallowing
›Your exam today did not show signs of an emergency airway problem
›Diet and activity
›Soft foods and small bites
›Sit upright for meals and for 30 minutes after eating
›Avoid alcohol and very hot liquids until improved
›Medications
›Take medicines exactly as prescribed
›If given a reflux medicine, take it daily as directed
›If antibiotics or antifungals were prescribed, complete the full course
›Follow up
›Arrange follow up as instructed
›If an endoscopy or swallowing study was recommended, schedule it as soon as possible
›Return to the emergency department now for
›Trouble breathing
›No ability to swallow saliva
›Drooling
›New or worsening chest pain
›Fever with worsening throat or neck pain
›Vomiting blood
›Black stools
›New weakness of face arm or leg
›Safety notes
›Do not drive if you received sedating medications today
›Avoid eating alone if you have choking episodes
19References/r18
Guidelines and core references
›Dysphagia evaluation and management guideline American Society for Gastrointestinal Endoscopy 2014
›Endoscopy role in dysphagia evaluation
›Food bolus and impaction management principles
›Esophageal physiologic testing clinical guideline American College of Gastroenterology 2020
›Manometry indications
›Functional lumen imaging probe context
›Ingested foreign body and food bolus impaction guideline European Society of Gastrointestinal Endoscopy 2016
›Emergent removal indications
›High risk objects
›Caustic ingestion management guideline European Society of Gastrointestinal Endoscopy 2017
›Early endoscopy timing considerations
›High risk ingestion features
›Candidiasis guideline Infectious Diseases Society of America 2016
›Fluconazole first line for esophageal candidiasis
›Alternative agents for refractory disease
›Surviving Sepsis Campaign adult guideline 2021
›Early antibiotics in septic shock
›Lactate guided resuscitation principles
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.