Massive Upper Gastrointestinal Bleeding with Gastroesophageal Balloon Tamponade

Publication ID Published Volume
10177 August 28, 2015 11

Abstract

The following simulation case is intended to prepare clinicians for a case of massive esophageal variceal bleeding in which the patient is unstable in a community hospital setting and a gastroenterologist/endoscopist is unavailable. The case is based on an actual case that presented through the emergency department and was admitted to a community hospital intensive care unit. The case offers a unique opportunity to practice with a gastroesophageal balloon tamponade (GEBT) device (Sengstaken-Blakemore tube or Minnesota tube)—a piece of equipment that is infrequently used and rarely trained with but potentially lifesaving in certain clinical settings.

We surveyed 17 individuals (one medical student, four interns, and 12 residents) regarding their prior experiences and knowledge of massive upper gastrointestinal (UGI) bleeding and gastroesophageal balloon tamponade (GEBT) device use. The simulation and training were then tested on five participants (one medical student, one intern, and three residents), during which the participants were faced with a case of massive UGI bleeding in a community hospital emergency department setting.

During the simulation session, participants accurately identified the major concerns, initiated appropriate resuscitative treatments, and discussed emergent consultations. They also considered using a balloon tamponade device but were initially unable to appropriately use the device. After training and a practice session, all participants had improved abilities and comfort levels with the GEBT device, as compared to baseline levels in untrained individuals.

Citation

Wanner G, Papanagnou D. Massive upper gastrointestinal bleeding with gastroesophageal balloon tamponade. MedEdPORTAL Publications. 2015;11:10177. http://doi.org/10.15766/mep_2374-8265.10177

Educational Objectives

By the end of this simulation, the learner will be able to:

  1. Recognize high-risk chief complaint and potential for decompensation in upper gastrointestinal (UGI) bleeding.
  2. Consider the differential diagnosis of UGI bleeding.
  3. Initiate appropriate resuscitative treatments and contact appropriate consultant(s).
  4. Consider and employ a gastroesophageal balloon tamponade device (Sengstaken-Blakemore tube, Minnesota tube, or similar device).

Keywords

  • Gastrointestinal, Bleeding, Hemorrhage, Esophageal and Gastric Varices, Balloon Tamponade, Balloon Occlusion, Emergency Medicine, Blakemore, Emergencies, Simulation, Hematemesis, Hybrid Simulation

References

  1. Cook D, Laine L. Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding. J Intensive Care Med. 1992;7(4):212-218.

  2. Winters ME, Panacek EA. Balloon tamponade of gastroesophageal varices. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Saunders Elsevier; 2014:831-836.

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ISSN 2374-8265