Esophogeal Varices

[firedoc5]

One of the worse kind of conditions you can encounter is Esophageal Varices (varicose veins of the esophagus). In the field IV and O2 is the best you can do that I know of. And a must I found out is measuring and saving the bloody emesis. Usually it's copious amount of bright red blood emesis. Patient also usually has hx. of alcoholism, but not always. Also ascertain if possible ingestion of a caustic substance.

[Ridryder 911]

???? Why would you want to save the emesis? I can assure you they will believe anyone that has a patient with a varices. Estimation of amount can be made.

Esophageal varices, used to have a poor outcome and was treated with Sangstain Blakemore Esophageal tubes attached to a football helmet for traction of the tube. (V.A. hospitals used have plenty of helmets) introduction of gastroscopy and the use of laser cauterization has remarkably improved the outcome.

Personally, I have used devices such as combitubes and even EOA that can occulude the espohagus, to help occlude the bleeding so intubation can occur.

Common problems of those with history of alcoholism and portal hypertension.

R/r 911

[firedoc5]

???? Why would you want to save the emesis? I can assure you they will believe anyone that has a patient with a varices. Estimation of amount can be made.

R/r 911

One occasion when another service brought in the patient and didn't save the emesis the ER doc got onto them, even though they did estimate the amount. Maybe it was just the one doc that preferred it. But one time when we did bring in a case both the nurse and the doc (a different one than before) said good that we saved it. So I've always advise to save it. I'm not sure if there is any other reason other than showing the amount.

We did discuss the use of an EOA especially if we had a longer ETA than we did, but took into consideration of the gag reflex.

[AnthonyM83]

I was told to save all abnormal emesis once...never do...

[AZCEP]

Saving the emesis would equate to carrying an extra 3-4 five gallon buckets of biohazardous material unsecured in the transporting unit.

Just like with snake, or spider bites, the ER staff does not need to see the actual volume.

[Doczilla]

There is no utility in saving the emesis in upper GI bleed. With a ruptured varix, bleeding ulcer, or hemorrhagic gastritis, there will be an uncertain volume of blood in the intestine that is moving through the digestive tract. Emesis is therefore an inaccurate way to estimate blood loss. Vital signs, physical exam, and to some extent lab values will determine the need for blood transfusion.

Complicating things is that the patient's varices most often result from liver damage. Since the liver makes clotting factors, liver damage will also produce a coagulopathy, which makes the bleeding much more difficult to control. Continued bleeding can be assumed.

'zilla

[Richard B the EMT]

In 34 years, I don't believe I've ever treated this, let alone transporting the emesis.

Would I be correct, that it could be checked with a sonogram unit, after arrival at the ED?

[Doczilla]

In 34 years, I don't believe I've ever treated this, let alone transporting the emesis.

Would I be correct, that it could be checked with a sonogram unit, after arrival at the ED?

No. The ultrasound can detect intraperitoneal blood, but not hemorrhage into the GI tract.

'zilla

[brock8024]

I thought these patients do not do well and usually die.

[Ridryder 911]

I thought these patients do not do well and usually die.

Usually these patients have other associated complications as well. I have to admit within the recent years the morbidity I believe has declined quite a bit, but still is not very good ( I don't have the complete data).

I come from the days of taking care of these folks with the "big Bertha Blakemore" esophageal tube. From what I recall many if they survived the initial bleed also presented with DIC shortly thereafter.

Definitely a "messy" and dangerous presentation.

R/r 911