Episode three works two mechanical emergencies that each hand you a recognition cue and a defined intervention with a clock embedded in it. For foreign bodies the urgency of removal follows the mechanism of injury, not the politeness of the object, sorting into three timing tiers from two-hour disc batteries to blunt objects that never come out. The food bolus doubles as the eosinophilic esophagitis biopsy opportunity that closes if you do not take it at the same procedure. For caustic ingestion, substance category drives the injury pattern, the airway is the first priority, and the Zargar grade at endoscopy drives short-term feeding and monitoring while late stricture and squamous cell carcinoma risk drive long-term surveillance. Topics covered Urgency follows mechanism, not the object Three timing tiers for removal Disc batteries, sharps, and magnets Drug packers versus stuffers Food bolus and the eosinophilic esophagitis gateway Alkali versus acid injury patterns Airway priority and contraindicated interventions Zargar grading and feeding safety Late strictures and cancer surveillance Key decisions Remove an esophageal disc battery within two hours because hydroxide drives alkaline liquefactive necrosis within two hours and can perforate, and remove esophageal obstruction with unmanageable secretions or a sharp esophageal object within six hours. Remove food bolus without complete obstruction, non-sharp esophageal objects, gastric or duodenal sharps, objects longer than six centimeters, and reachable high-power magnets within twenty-four hours, while managing blunt asymptomatic post-duodenal objects expectantly. Do not endoscope body packers or stuffers because rupture during retrieval risks a fatal toxic dose, reserving laparotomy for symptoms of leak. Take at least four biopsies from proximal and distal esophagus at the same procedure when no eosinophilic esophagitis diagnosis exists, since roughly half of adult food bolus impactions trace to it and the histologic threshold is fifteen eosinophils per high-power field. Prioritize the airway in caustic ingestion because alkali can cause supraglottic edema, and avoid induced emesis, activated charcoal, chemical neutralization, and acute nasogastric intubation. Endoscope caustic ingestion within twelve to twenty-four hours and let the Zargar grade decide: grades zero through two-A feed and observe, two-B and three delay feeding with ICU monitoring and surgical consult, and grade four operate, with dilation in one-to-two-millimeter increments toward fourteen to fifteen millimeters for late strictures. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected].

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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