Comments on: EMCrit Podcast 5 – Intubating the Critical GI Bleeder http://emcrit.org/podcasts/intubating-gi-bleeds/ Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation Thu, 17 May 2012 06:35:19 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Kevin Spencer http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-7615 Kevin Spencer Sat, 07 Apr 2012 02:32:29 +0000 http://emcrit.org/?p=62#comment-7615 I have said before... Love your podcast. So yesterday I just had a GI bleeder that started crashing, but was able to stabilize and thankfully didn't have to intubate. Now in hindsight I am here reviewing the "what if's" and googling "Intubate the GI Bleeder", and the first thing that pops up on google is this podcast, which it turns out I have alreaded downloaded onto my iPhone (along with all your podcasts), but hadn't yet listened to this one. So, thanks again for this (and every) posting, please keep them coming. This brings me to my question: Any chance you can do a top to bottom review of the ER variceal GI Bleed management (beyond the airway, which you have covered)? Would love to see your algorithm and rational with regards to octreotide, FFP, Pantoloc, etc... I have said before… Love your podcast. So yesterday I just had a GI bleeder that started crashing, but was able to stabilize and thankfully didn’t have to intubate.

Now in hindsight I am here reviewing the “what if’s” and googling “Intubate the GI Bleeder”, and the first thing that pops up on google is this podcast, which it turns out I have alreaded downloaded onto my iPhone (along with all your podcasts), but hadn’t yet listened to this one. So, thanks again for this (and every) posting, please keep them coming.

This brings me to my question: Any chance you can do a top to bottom review of the ER variceal GI Bleed management (beyond the airway, which you have covered)? Would love to see your algorithm and rational with regards to octreotide, FFP, Pantoloc, etc…

]]> By: Mike http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-7363 Mike Wed, 14 Mar 2012 16:44:51 +0000 http://emcrit.org/?p=62#comment-7363 Scott, I just had a woman with right sided lung CA who developed MASSIVE hemoptysis...actually was just pouring out blood from lungs. She quickly went into respiratory arrest then cardiac arrest. We suctioned 500 mL of blood from her mouth and airway in the first 3 minutes. I called anesthesia (first time I ever thought I wouldn't be able to intubate someone), couldn't find a meconium aspirator, but anesthesia intubated anyway, though we couldn't confirm due to amount of blood. Then of course we couldn't ventilate her. She died, and I think it was 1. from respiratory then cardiac arrest and no ventilation or 2. bled to death. What I was wondering was if you had any suggestions of handling this? I've heard of single sided bronchus intubation but neither anesthesia nor I knew how to do it. Any suggestions, or was she doomed from the beginning? Thanks, love your podcast and learn something every episode. Scott, I just had a woman with right sided lung CA who developed MASSIVE hemoptysis…actually was just pouring out blood from lungs. She quickly went into respiratory arrest then cardiac arrest. We suctioned 500 mL of blood from her mouth and airway in the first 3 minutes. I called anesthesia (first time I ever thought I wouldn’t be able to intubate someone), couldn’t find a meconium aspirator, but anesthesia intubated anyway, though we couldn’t confirm due to amount of blood. Then of course we couldn’t ventilate her. She died, and I think it was 1. from respiratory then cardiac arrest and no ventilation or 2. bled to death.

What I was wondering was if you had any suggestions of handling this? I’ve heard of single sided bronchus intubation but neither anesthesia nor I knew how to do it. Any suggestions, or was she doomed from the beginning? Thanks, love your podcast and learn something every episode.

]]> By: emcrit http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-497 emcrit Sun, 03 Jan 2010 04:20:42 +0000 http://emcrit.org/?p=62#comment-497 Taku, Absolutely! I had LMA in number 6, but an ILMA would be even better if you have them. Scott Taku,

Absolutely! I had LMA in number 6, but an ILMA would be even better if you have them.

Scott

]]> By: Taku Taira http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-496 Taku Taira Sun, 03 Jan 2010 03:47:00 +0000 http://emcrit.org/?p=62#comment-496 I would add that this is a time that you want to have a blind technique ready like the Intubating LMA... although a bougie is technically a blind technique ILMA, would be better... (saved me the last time i saw a mouth full of blood despite 2 yankauers) I would add that this is a time that you want to have a blind technique ready like the Intubating LMA… although a bougie is technically a blind technique ILMA, would be better… (saved me the last time i saw a mouth full of blood despite 2 yankauers)

]]> By: phil http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-18 phil Mon, 22 Jun 2009 13:54:51 +0000 http://emcrit.org/?p=62#comment-18 Great checklist for the next UGIB intubation, Scott. As I watched an oropharynx fill with coffee grounds a couple months ago, I was reminded of that really large bore perforated suction catheter on display at an ACEP SA past. Couldn't find it just now, after doing a quick search online, but a larger bore catheter and tubing would go along well with the meconium aspirator. Great checklist for the next UGIB intubation, Scott.

As I watched an oropharynx fill with coffee grounds a couple months ago, I was reminded of that really large bore perforated suction catheter on display at an ACEP SA past. Couldn’t find it just now, after doing a quick search online, but a larger bore catheter and tubing would go along well with the meconium aspirator.

]]> By: reuben http://emcrit.org/podcasts/intubating-gi-bleeds/#comment-17 reuben Mon, 22 Jun 2009 08:02:47 +0000 http://emcrit.org/?p=62#comment-17 great summary scott. additional thought: although you want to not bag, if you must bag, you want to minimize the amount of air transmitted to the stomach. So abort your laryngoscopy attempts <b>earlier</b> so you're more likely to bag slowly, gently, and, even better - through an LMA. great summary scott. additional thought: although you want to not bag, if you must bag, you want to minimize the amount of air transmitted to the stomach. So abort your laryngoscopy attempts earlier so you’re more likely to bag slowly, gently, and, even better – through an LMA.

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