Esophageal Varices Anyone?

[KosherMedic]

I have seen three SB tubes. I have never put one in. In theory, they slide in like an OG. The one thing I have always wonder is how!! They are much more flacid than an oralgastric tube. How do you keep it from curling up. Just wondering.

http://en.wikipedia....-Blakemore_tube

This link says that those who have the SB tubes usually keep them in the refrigerator. They probably do that to make the tube more rigid.

[HERBIE1]

As touched on by Flight, the goal with utilising vasopressin is hemorrhage control by constriction of arterioles. Vasopressin is actually very effective at initial hemorrhage control, but re-bleeding can occur quite frequently.

Take care,

chbare.

Am I out of the loop here or do a lot of services use vasopressors(for any reason) in a prehospital setting? If so, how many times have they been used by someone here? Years ago we used to have inderal, but I never heard of it being used and it was finally pulled. I imagine in some systems- especially where there are long transport times, they can be of some use.

As for varices, I understand the theory behind it, but like I said, if the person is shocky from hypovolemia, I still do not see the value of a pressor, especially when the vessels involved are far larger than an arteriole.

[DartmouthDave]

Hello,

Herbie1,

I am talking about Vasopressin (Pitressin). As opposed to giving Epinephrine 1mg IV give Vaopressin 40 units IV during the code. Like when this poor fellow coded on CM. In theory, this may cause the varacies to constrict and diminish the bleeding. A two-for-one deal.

As opposed to a vasopressor such as Levophed, Phenylepherine and Dopamine. Stuff like that. Which you are 100% correct would be a bad idea before that tank is filled so to speak.

Correct me if I am misunderstanding what you are saying.

Chbare,

All of the SB tubes that I have seen were inserted in smaller hospitals (not sure how) and were transfer to us. One was secured to a hockey helment and two to the ET tube. Basically, the labs were corrected and the tubes were pulled and the patients scoped. I agree 100% that messing around with a SB in the pre-hospital setting or by unskilled hands in the hospital is a bad idea.

KM,

Good to know. All the SB that I have seen are just laying around. Most, looked like they were made in 1942.

Lastly.... =)

One problem that we did have with one patient was excessive pressure in the SB. There was some esophageal ischemia. Also, deflating the tube seems to pull off all the clotting that has formed as well.

Cheers...

Edited April 18, 2010 by DartmouthDave

[chbare]

Am I out of the loop here or do a lot of services use vasopressors(for any reason) in a prehospital setting? If so, how many times have they been used by someone here? Years ago we used to have inderal, but I never heard of it being used and it was finally pulled. I imagine in some systems- especially where there are long transport times, they can be of some use.

As for varices, I understand the theory behind it, but like I said, if the person is shocky from hypovolemia, I still do not see the value of a pressor, especially when the vessels involved are far larger than an arteriole.

The emphasis is on controlling the bleeding with vasopressin infusions, not treating hypovolemic shock. We also must remember the vessels involved are veins, and arterioles eventually branch out into capillaries, and capillaries eventually lead to veins. Therefore, constricting arterioles up stream so to speak can assist with controlling the venous bleeding downstream.

Take care,

chbare.

[Kaisu]

Anybody who has seen a SB tube should understand the irony of that dichotomy.

Gotta love EMS.

great info on vasopressin. I was under the impression that AHA included it in the guidelines as a political move when they brought the Europeans into the game for the first time. Europeans use it in codes instead of epi.. and they were shocked.. Ver is da vasopressor????

We carried it in Wisconsin for a few years... but I dont have it as an option in my drug box here in AZ.

We made the decision to go surgical crike as opposed to KwikTrake to facilitate suctioning.. and there was a lot of suctioning. The thing is... the code ran like a clock... and it was a wasted effort because we had no way of addressing the root cause of all this stuff... the guy had pretty well bled out by the time we got there.

The ED doc says to me " what can you tell me about this patient besides the fact that he's got a big hole in his throat?"

I said "He's dead"

We did get kudos tho for a well done trach....

[croaker260]

Bear:

I think there is a world of difference between inserting a Combi/King?PTLA/EGTA and inflating until you cant no more, and inserting a Blakemore and carefully monitoring the pressure.

The last Blakemore tube I transported we kept saline in the bladder instead of air, although that as mainly due to thats what we did with ETT's when we flew them back in the day. Not sure if that was overkill or not. This was 9 or 10 years ago.

[chbare]

Gotta love EMS.

great info on vasopressin. I was under the impression that AHA included it in the guidelines as a political move when they brought the Europeans into the game for the first time. Europeans use it in codes instead of epi.. and they were shocked.. Ver is da vasopressor????

We carried it in Wisconsin for a few years... but I dont have it as an option in my drug box here in AZ.

We made the decision to go surgical crike as opposed to KwikTrake to facilitate suctioning.. and there was a lot of suctioning. The thing is... the code ran like a clock... and it was a wasted effort because we had no way of addressing the root cause of all this stuff... the guy had pretty well bled out by the time we got there.

The ED doc says to me " what can you tell me about this patient besides the fact that he's got a big hole in his throat?"

I said "He's dead"

We did get kudos tho for a well done trach....

The vasopressin for arrest change is due to literature reporting that in certain cases of arrest, the survival to admission rates were higher in the vasopressin groups. I think survival to admit rates were much higher in asystole groups.

Bear:

I think there is a world of difference between inserting a Combi/King?PTLA/EGTA and inflating until you cant no more, and inserting a Blakemore and carefully monitoring the pressure.

The last Blakemore tube I transported we kept saline in the bladder instead of air, although that as mainly due to thats what we did with ETT's when we flew them back in the day. Not sure if that was overkill or not. This was 9 or 10 years ago.

Yes and no. Clearly, the risks associated with SB insertion are pretty significant under the best of circumstances. Hence, the reason SB treatment as a primary modality has fallen out of favour in recent years.

Take care,

chbare.