The Niagara falls of GI bleeding is occuring before your eyes. The patient is hypotensive and altered. What is your medical management algorithm and how do you deal with a grossly contaminated airway? What rescue device will you use? At EMU 2019, Dr. Sara Gray takes us through one of her best cases of damage control resuscitation for a patient with massive GI bleeding.
Damage control bedside resuscitation for massive GI bleeding: key points
- Resuscitate before you intubate
- Double set up, preoxygenate well
- Multiple suctions, consider SALAD (Suction Assisted Laryngoscopy Airway Decontamination): intubate esophagus with suction to divert blood from airway
- Have bougie on hand with ETT loaded
- Replace losses with Massive Transfusion Protocol (MTP)
- Give GI specifics: ceftriaxone, pantoprazole, octreotide
- Stop the bleeding
- Rescue device – balloon tamponade: What, where and how?
- What: know what you have where you work (Linton, Blakemore or Minnesota)
- Where: know where it is stocked
- How: know how to use device, must confirm balloon is below the diaphragm and in the stomach before full inflation to avoid catastrophic esophageal injury
- Interventional radiology
Dr. Sara Gray is cross-trained in Emergency Medicine and Critical Care. She works in both areas at St. Michael’s Hospital and is an Associate Professor at the University of Toronto. She is also the Medical Director for Emergency Preparedness at St Mike’s. Her academic interests include patient safety and knowledge translation; specifically how to optimize the care of critically ill patients in the ED.
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