Esophogeal Varices

[Doczilla]

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

"Patients who have bled once from esophageal varices have a 70% chance of rebleeding, and approximately one third of further bleeding episodes are fatal. The risk of death is maximal during the first few days after the bleeding episode and decreases slowly over the first 6 weeks. Mortality rates in the setting of surgical intervention for acute variceal bleeding are high.

Associated abnormalities in the renal, pulmonary, cardiovascular, and immune systems in patients with esophageal varices contribute to 20-65% of mortality...

...High morbidity and mortality (30-40% of the group with severe persistent GI hemorrhage) - Factors such as underlying liver disease and associated abnormalities of the renal, cardiovascular, and immune systems contribute to the high morbidity and mortality."

-eMedicine

In my experience, they don't USUALLY die, but certainly can. And I have seen plenty of patients in my ER who have a ruptured esophageal varix in their medical history, so most do actually survive.

'zilla

[firedoc5]

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

We found out expensive those big Bertha Blakemore's cost when one of the nurses almost forgot one at the receiving the hosp. that we transferred the patient to. We started walking out the door when she remembered it.

[Richard B the EMT]

Last night's "NCIS" (Feb. 5, 2008) had "Ducky" mention this condition as a part of an autopsy of a Eubonic Plague-like condition exhibiting corpse discovered on board a ship.

Coincidence?

[VentMedic]

We found out expensive those big Bertha Blakemore's cost when one of the nurses almost forgot one at the receiving the hosp. that we transferred the patient to. We started walking out the door when she remembered it.

Did she take the Blakemore from the patient?

[Ridryder 911]

Wow! Did I boo-boo :oops: .. I totally screwed up the spelling of the Sengstaken Blakemore tube.. Sorry! It has been several years since I've used one.

For those that wonder what a "big bertha" looks like here is a pic as well how the Senstaken Blakemore is positioned.

[VentMedic]

We used a football helmet to secure the Blakemore tube.

[Ridryder 911]

We used a football helmet to secure the Blakemore tube.

Awww. I remember in my youth, my first V.A. ICU clinical (which I believe everyone should have to attend an VA clinical) the rows and rows of football helmets. Truthfully, I had no idea what the hell why would an ICU need so many helmets... only until later on that night, I had my first date with Big Bertha I understood there was more than one reason for masks on football helmets.

I found this why reviewing Varicies and found some of the numbers interesting......

"The management of oesophageal bleeding disorders remains a challenging problem in the emergency department. Oesophageal varices are dilated veins; they are most commonly a result of portal hypertension and are often associated with a poor outcome.1 Haemorrhage from oesophageal varices is a life-threatening emergency with a mortality rate of 30–50%. Approximately 90% of patients with cirrhosis will develop varices, of which bleeding occurs in 25–35%. Balloon tamponade is one of the methods for temporary control of acute variceal haemorrhage and works by directly compressing the varices at the bleeding site. Placement of a Sengstaken–Blakemore tube into the gastric fundus controls variceal bleeding via a tamponading effect. However, incorrect placement of the tube with inflation of the balloon in the oesophagus may cause oesophageal perforation or extrinsic compression of the trachea"....

Placement confirmation of Sengstaken–Blakemore tube by ultrasound

A C-M Lin, Y-H Hsu, T-L Wang, C-F Chong3 ;Emergency Medicine Journal 2006;23:487; doi:10.1136/emj.2005.031922

Now you why I will not place those NG tubes down the alkies.

[VentMedic]

Now you why I will not place those NG tubes down the alkies.

I initially did my OJT as an RT at the VA after several years as an EMT-P. Needless to say, if I thought I was good at intubating in the field, I achieved perfection at the VA. Esophageal placement was not an option.

[Richard B the EMT]

1) I had never seen or heard of this device prior to EMT City.

2) Confirm, please: This monster was used by nasal insertion?

3) I can understand the usage of the face guard portion of a football helmet to secure this ...this...THING!

[Ridryder 911]

They are still used, although not as much. Yes, they can be inserted nasally (although I would not suggest or want it myself). I have seen it done, (amazing how much a nasal nare can stretch)...

R/r 911