1. Massive Upper Gastrointestinal Bleeding With Gastroesophageal Balloon Tamponade
- Author
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Gregory Wanner and Dimitrios Papanagnou
- Subjects
Emergencies ,Simulation ,Emergency Medicine ,Hemorrhage ,Bleeding ,Gastrointestinal ,Medicine (General) ,R5-920 ,Education - Abstract
Abstract Introduction 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. Methods While running the simulation, a senior (third-year) emergency medicine resident manages the case while a junior resident, intern, and medical student participate in the resuscitation. An emergency medicine faculty member observes from behind a one-way glass and acts as the instructor. After the simulation case is completed, a debriefing was held followed by GEBT device instruction and practice. Results We initially tested the simulation scenario with a total of 5 participants (1 medical student, 1 intern, 1 junior resident, and 2 senior residents). An additional medical student volunteered to act as the patient. Simulation participants performed well with the initial evaluation, resuscitation, and airway management during the initial portion of the simulation session. On pre-and posttest evaluations using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) participants indicated increased comfort with making the decision to use a GEBT (pretest mean = 2.82, posttest mean = 3.8), and comfort with actually using a GEBT (pretest mean = 2.12, posttest mean = 3.8). Discussion This simulation case offers a unique opportunity to practice with a GEBT device. 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.
- Published
- 2015
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