Vomiting Blood During Full Arrest

TomB said:
Good for him. There is a lot of narrative fallacy in medicine. "He was purple from the nipple line up so he must have had a massive PE." I respect people who say they don't know unless they actually know.
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Agreed, however when new provider asks a question it would be more beneficial to throw out some common differentials instead of just saying "no clue".
 
He wasn't even intubated! All we did was put in an OPA, bag him, and do compressions. At least the medic admitted that he had no clue. Most of them couldn't do that, what with their giant ego XD
 
Bleeding diathesis could had been caused by many factors. Anything like described such as varicies (ruptured hemorrhoids in the esophagus) do doubt that many of you have ever seen a Sengstaken Blakemoore tube in use). Could have been cirrhosis of liver, good ole GI bleed, ASA OD.. and so forth
 
Ridryder911 said:
Bleeding diathesis could had been caused by many factors. Anything like described such as varicies (ruptured hemorrhoids in the esophagus) do doubt that many of you have ever seen a Sengstaken Blakemoore tube in use). Could have been cirrhosis of liver, good ole GI bleed, ASA OD.. and so forth
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I love Blakemoore tubes. "Why do you have a football helmet in the supply room?"
 
Chase said:
I love Blakemoore tubes. "Why do you have a football helmet in the supply room?"
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Does not look comfy. Hopefully this kinda patient gets some anxiolytic agent?
 
Chase said:
They are all intubated and heavily sedated.
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Why do y'all put a helmet on them anyways?


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Mallord-Weise tears and Boorhaves don't typically bleed much. But, if the person was coagulopathic, that could change. Varices can bleed horrifically. I've also seen MASSIVE hemoptysis due to malignancy. It's possible that he could have had an upper GI bleed.

Anyhow, for what it is worth, I have placed a blakemoore tube (with GI on the phone to help with verbal instructions). The reason for the football helmet is that traction is required for the gastric balloon to work if there is proximal gastric/distal esophageal bleeding. The helmet is just one way to ensure traction, but it has the advantage of providing a point of traction that is attached to the patient, especially if they need to be rolled or moved. One down side to the helmet is it make is easier to dislodge the ETT when taking it on or off.
 
EpiEMS said:
FTFY ;)

So you've got an ETT in first then this tube? How does that work out?
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Dang autocorrect always changing what I meant to type! :p

Here's a link and some videos on placement:

https://emcrit.org/procedures/blakemore-tube-placement/

I won't be able to explain it very well, but basically, you insert it in a similar way as an OGT (the tubes shouldn't interfere with each other). The ETT tube (clearly) blocks off the trachea, and the Blakemore goes into the esophagus and down into the stomach, and provides tamponade to bleeding esophageal varices to halt the bleeding. Hopefully that helps a little bit?
 
@medichopeful, very helpful! Thanks! (I love EMCrit, it is often my go-to reference for procedures that I know nothing about!)
 
EpiEMS said:
@medichopeful, very helpful! Thanks! (I love EMCrit, it is often my go-to reference for procedures that I know nothing about!)
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I last saw one of these used not so late in the 20th century. Flexible endoscopy has more or less replaced them.

Anyone still seeing these with any regularity? Like in the past year?
 
E tank said:
I last saw one of these used not so late in the 20th century. Flexible endoscopy has more or less replaced them.

Anyone still seeing these with any regularity? Like in the past year?
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I have seen it once. By the time it takes you to set up and actually place the thing GI is at the bedside to scope. I am assuming it would be more common in rural ERs without GI available on call.
 
@E tank
Relevant:
616La9W8B3L._SY300_.jpg

Also relevant, are ED physicians performing this procedure, or are they calling GI or surgery?
 
EpiEMS said:
@E tank
Relevant:
Also relevant, are ED physicians performing this procedure, or are they calling GI or surgery?
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This is usually done by the ED physician as a temporizing measure until GI can get there. Definitive treatment is endoscopy. Almost like placing a tourniquet.
 
EpiEMS said:
@E tank
Relevant:
616La9W8B3L._SY300_.jpg

Also relevant, are ED physicians performing this procedure, or are they calling GI or surgery?
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Saw one in my little rural ED a year or so ago. PT was flown to da big city. Where he subsequently expired.
 
Chase said:
This is usually done by the ED physician as a temporizing measure until GI can get there. Definitive treatment is endoscopy. Almost like placing a tourniquet.
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It is also done by intensivists and GI. And really, it can be placed by anyone. Also, endoscopy can only do so much. In the patient that I placed a Blakemore, he had been scoped multiple times and had a blakemore placed at least once previously. GI did not immediately re-scope him. Really, what the definitive treatment is for these patients is reducing portal pressure, which is often accomplished by going to IR for TIPS (Transjugular intrahepatic portosystemic shunt), and down the line they will need a transplant if they are a candidate for such.
.
 
TomB said:
Good for him. There is a lot of narrative fallacy in medicine. "He was purple from the nipple line up so he must have had a massive PE." I respect people who say they don't know unless they actually know.
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Indeed. What´s wrong with guys that see it as a sign of incompetency. No matter how experienced, you won´t always know, unless you are pretending to.
 
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