Esophageal meat impaction can be a challenge for the emergency physician. Historically, meat impaction has been treated with nitroglycerin, glucagon, and E-Z-gas. Patients who fail to respond to these treatments lead to a call to the gastroenterologist on duty for an emergent endoscopy.
I work with a flight nurse at St. Tammany Parish Hospital who taught me a little trick. Heat up eight ounces of water, and have the patient take a mouthful and swallow with the neck in extension. Several attempts usually resolve the meat impaction. I then refer the patient to a gastroenterologist for outpatient evaluation.
In honor of the nurse, Angel, who taught me this, I call it the Angel Maneuver. Since implementing this treatment in the ED, none of my patients have made an emergent visit to endoscopy.
Elisa M. Arrillaga, MD