Blakemore tube

[roja]

How many have you put in?


(I have put in one in 5 years, and heard of 3 others at our hospital).


Just had the WORST GI bleed last week and was curious

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[dchristismi]

I had a horrific UGIB a couple of months ago - ESLD, varices, came in hypotensive, pesudo-stabilized, then more blood, more blood, more blood spraying everywhere. We discussed it when we pseudo-stabilized him again, managed to find one, and all stood there staring at it. Shipped him to the ICU where GI emergently scoped him, couldn't control the bleeding, and placed the Blakemore as a last-ditch attempt during the code.

So I guess, none, but we did talk about it that once. Was the only time in the last 3 years I'd heard it mentioned. (Which makes our perimortem c-section rate slightly higher than our Blakemore rate.)

One of the attendings starting going on about the "good old days at the VA where everyone got one..."

 

[BADMD]

How many have you put in?

I've done 2. One in the ED and one as an ICU resident. I would be perfectly happy to never do one ever again. To call it a mess is an understatement.

 

[Apollyon]

Tried once as a resident - GI bleeder that tried (and succeeded) to kill herself by drinking a gallon of antifreeze.

Mess? Hell yes. Help? Hell no.

I do revel in the Ewalds, though. Don't be dumb enough to tell me that you took "a handful of pills" "30 minutes ago", or wonder why I'm smirking when your lavage comes back clear and sans pills.

 

[docB]

Never done one, never seen one. I don't thing we even have them in any of the places I work. Doesn't mean I would try one in a Hail Mary if I could find one.

 

[pinbor1]

I did my first and hopefully last blakemore on a heroin addict/alcoholic that came in as an overdose. Then he got out of bed and started vomiting blood. Intubated and placed the blakemore. Ended up giving blood products and stabilized him to send him to the ICU while waiting for GI to come in. Then they opted not to scope him and he bled out in the evening.

 

[USCDiver]

We were going to put in one while I was on my MICU rotation. Patient was a 40ish woman in ESLD with huge bleeding varices. GI was there, but the damn attending wouldn't scope her without consent. The husband was drunk AND not reachable because he was driving to the hospital

Anyway, we had the Blakemore all ready to go with the football helmet... but we didn't have the damn pressure valves and other necessary peripherals. So we called one of the other regional hospitals and asked them to send theirs on the helicopter that was just leaving their place with a trauma patient. The equipment arrived but it was the wrong stuff. I gave up watching the GI attending freak out because he was unaware of the concept of emergent consent (does he consent people for CPR?).

The only other similar case I ever heard of happened to a medical school classmate of mine. Huge large volume UGI bleed. On scope they found an aorto-esophageal fistula! No Blakemore was available so they shoved like 10 foleys down there one at a time inflating the balloons as they went up. I can only imagine seeing this woman with 10 foley tubes coming out of her mouth.

 

[DOnut]

Did 1 two months ago as the ICU resident. Cardiology was doing a TEE on a guy and didn't know he had a hx of varicies. Anyway, ruptured one and the was bleeding bleeding bleeding everywhere. Hypotensive in the 40's. Gave blood, dopamine, levophed.....even activated factor VIIa. After that I convinced the attending to let me place the Blakemore tube. It worked and was awesome. Left it in for 24 hours reading the freakin directions on the box adjusting the balloon pressure, then removed it and let GI band him. It worked great, but the guy died 1 week later. Still a great save at the time.

 

[DocFrog]

helped with one on my ICU rotation as a med student...alcoholic, cirrhotic, varices, etc. Pt's hgb kept dropping, but not a massive bleeding varices pt. He had failed TIPS and failed banding, so the attending decided to put in a blakemore as a last ditch effort. I'm ashamed to say I don't remember how the guy ended up doing, but it was neat to see.

Then, while I was on an ER rotation elsewhere we had a ruptured varices patient die "because" no one restocked the ED's blakemore...oops

 

[roja]

helped with one on my ICU rotation as a med student...alcoholic, cirrhotic, varices, etc. Pt's hgb kept dropping, but not a massive bleeding varices pt. He had failed TIPS and failed banding, so the attending decided to put in a blakemore as a last ditch effort. I'm ashamed to say I don't remember how the guy ended up doing, but it was neat to see.

Then, while I was on an ER rotation elsewhere we had a ruptured varices patient die "because" no one restocked the ED's blakemore...oops

Realize that your patient was probably going to die anyway. The blakemore probably would have just delayed it a bit.

 

[Rendar5]

Don't feel too bad. My uncle had a blakemore put in, and it bought him a few hours, but made no difference in the end. Although, I have to thank them for getting it in since my grandpa and dad were able to make it to the hospital in time to say goodbye.

 

[Egon]

Blakemore tubes do not change mortality, at least in retrospective studies...

With that said I asked for one a few months back, we didn't even stock them in the hospital anymore. (Worst GI bleed I ever had, PROFUSE UGI bleed, alcoholic, suspected arterial source, GI couldn't visualize, PLTs were 18 and we gave him all we had in the hospital, 12 units of blood, FFP, Ca, vasopresin, pressors, the works...you know the result and I don't think a Blakemore would have changed it, but I would have liked to have it in...)

 

[ditch doctor]

You know, if I ever invent something, I'm not going to invent it with someone. Sengstaken probably did more work than Blakemore, but nobody calls it just a "Sengstaken" tube. It's either "Sengstaken-Blakemore" or just a "Blakemore". Blakemore was probably the alcoholic poon-hound. Sengstaken got screwed.