ORALS - GI SCRIPTS

Question 1

Indications, complications and contraindications to a Blakemore tube

Answer 1

Complications:
airway obstruction
esophageal rupture
aspiration pneumonitis
pain
pressure ulcers (lips, mouth, nose, tongue)
mucosal erosions of esophagus + stomach
dislodgment of prior variceal bands

Indications
unstable patient + massive variceal bleed PLUS
endoscopy not available
endoscopy not successful
consultant team unavailable

Contraindications
hx of esophgeal stricture
recent esophageal or gastric surgery

Question 2

MASSIVE GIB SCRIPT

Answer 2

1. PPE/MOVID
   resus team, RT, additional ERP
   pre-alert GI bleed team
   bloodwork - type and screen, INR
2. Management
   MTP to resus (HgB >70 / CAD >80)
   PPI 80mg IV then 8mg/hr
   hx of cirrhosis - CTX 1g IV
   Undifferentiated or variceal - octreotide 50mcg IV
   reversal for anticoagulation
   history of aortic graft - CT angio (r/o aortoenteric fistula)
   LGIB - CTA to localize lesion (IR vs gen surgery)
3. Potentially intubated (CONTAMINATED AIRWAY script)

Question 3

Contents of an MTP

Answer 3

BOX 1: 4RBC, 2FFP
BOX 2: 4RBC, 4FFP, 1PLT
CaCl, INR/fibrinogen
BOX 3: 6RBC, 6FFP, 1PLT
4g fibrinogen (10U cryo)