›Max daily dose per local policy
›Ibuprofen PO 10 mg/kg (max 600 mg per dose) if no contraindication
›Interval every 6-8 hours
›Avoid in significant GI bleeding concern
›If severe pain, opioid titration with monitoring (Class IIa)
›Fentanyl IV 0.5-1 mcg/kg
›Repeat every 5-10 minutes to effect
›Nausea control strategy
›Ondansetron ODT or IV 0.15 mg/kg (max 8 mg)
›Repeat every 8-12 hours as needed
›QT risk consideration in predisposed patients
Esophageal food bolus management
›Food impaction pathway
›Airway risk and secretion intolerance
›If secretion intolerance, endoscopy without pharmacologic delay (Class I)
›If stable and tolerating secretions, brief medical trial acceptable (Class IIb)
›Medical therapy options
›Glucagon IV 0.5-1 mg
›Limited efficacy
›Nausea and vomiting risk
›Carbonated beverage PO in fully stable patient
›Avoid with obstruction symptoms or aspiration risk
›Avoid with suspected perforation
›Underlying disease evaluation
›Eosinophilic esophagitis suspicion with recurrent impaction
›Stricture or ring suspicion with dysphagia history
Button battery specific adjuncts
›Pre-endoscopy mitigation in selected pediatric cases
›Honey or sucralfate while awaiting removal when ingestion within 12 hours and able to swallow (Class IIa)
›Honey 10 ml every 10 minutes up to 6 doses for age over 1 year
›Sucralfate 1 g slurry every 10 minutes up to 3 doses
›Contraindications to oral mitigation
›Secretion intolerance
›Suspected perforation
›Airway compromise
Antibiotics and complication management
›Infection and perforation coverage
›Suspected mediastinitis or perforation
›Piperacillin-tazobactam IV 3.375 g every 6 hours (adult dosing example)
›Pediatric weight-based dosing per local formulary
›Renal adjustment
›Ceftriaxone IV 2 g daily plus metronidazole IV 500 mg every 8 hours
›Alternative for beta-lactam allergy per local protocol
›Source control planning with surgery
›Tetanus prophylaxis considerations
›Mucosal laceration with contaminated object history
›Vaccination status review
Surgical management triggers
›Operative indications
›Peritonitis
›Exploratory surgery planning
›Broad-spectrum antibiotics
›Magnet ingestion with symptoms and non-progression
›Concern for fistula or necrosis
›Urgent surgical evaluation
›Sharp object beyond pylorus with complication signs
›Focal tenderness
›Fever
›Free air
Procedural sedation and airway planning
›Sedation readiness
›Aspiration risk reduction
›Strict NPO when possible
›Suction availability
›Airway management planning
›Proximal esophageal object and drooling
›Anticipated difficult airway due to edema
›Evidence level notes
›Airway protection for secretion intolerance prioritized (Class I)
›Multidisciplinary endoscopy and anesthesia planning for high-risk objects (Class I)