I've been at this for a while, and have never seen someone hemorrhage so much from their varices. For the unitiated, varices are like hemorrhoids, but are at the bottom of your esophagus instead of in your anus... They're the end result of years of hard drinking.
For such a new blog, this is my second GI Bleeding post, but this one was even more impressive than the last one.
The man came in in cardiac arrest, and we were able to resuscitate him and get a pulse back. The paramedics told us that he had been vomiting blood at home, so we inserted a naso-gastric tube to wash out his stomach and see. After inserting the tube, we started to suction buckets of blood out of him and had to start a massive transfusion protocol. After suctioning out over 5 liters of blood, and transfusing over 20 units of blood, the surgeons were considering taking him to the OR and the GI doctors were considering getting out of bed to come see the patient; we decided to use a Sengstaken-Blakemore tube, to try to staunch the flow of blood. Follow the link to see the diagram of how to insert one of these tubes. It's an elaborate set up and not done very often--- at least not at our institution. The tube has to be tied to a football helmet to keep tension on it. You blow up a balloon at the end of the tube and pull it back so it puts pressure on the junction between the stomach and the esophagus. Then you blow up a balloon that runs along the length of the tube within the esophagus to tamponade the bleeding.
He ended up getting 54 units of blood while he was in the ER. There were a lot of doctors and nurses working furiously to try to save this guy's life. The surgeons took him to the OR, but couldnt find the source of bleeding, so he ended up getting a TIPS procedure by the interventional radiologists.
He died shortly after the procedure; but not for our lack of trying to save him...
No comments:
Post a Comment