Does anyone have a protocol they use for determining whether egds get tubed or not. Aside from the obvious ones (emergency npo violation, vomiting, food bolus, bleeding varices) does anyone have a protocol they use for the gray area ones…. Like a little melena but now stabilized hb. A couple of our gi drs are always pushing to “just take a look.” Personally I have no problem pushing right back but was looking for a protocol to help some of my nicer colleagues get out of the conversation easier.
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Egd and intubation?
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Arch Guillotti
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Guess.
I do mac for almost all egds but if there's any question I just tube and no one questions me.
Recent hematemesis (~6-12 hrs) regardless of hgb is a tube for me. So is melena with unstable hgb (brisk bleed) and pt who is actively getting transfused (currently receiving or received within the last 6-12 hrs)
I don't routinely tube melena with stable hgb, although if you're concerned you can ask GI to give a dose of erythromycin or reglan to empty out the stomach a bit.
Pre-endoscopic erythromycin administration in upper gastrointestinal bleeding: an updated meta-analysis and systematic review - PMC
In patients suffering from upper gastrointestinal bleeding (UGIB), adequate visualization is essential during endoscopy. Prior to endoscopy, erythromycin administration has been shown to enhance visualization in these patients; however, guidelines ...
www.ncbi.nlm.nih.gov
In these cases where the decision isn’t obvious, I’ll use factors like elevated BUN or patient hunger to guide me. Gut/clinical instinct matter - trust it. Other than a few extra min and not being perceived as “slick” by the endo nurses who just want to go home, I rarely regret GETA.
It’s like an A-line. Probably under-utilized and NEVER regretted.
Agreed recent Vomiting I tube. Achalasia with dilation I tube. Recent Hematemisis less than 12 hrs tube. Food bokus tube.
got a call recently from endoscopy. they do their own sedations with nurses, fent/midaz. call was for intubation in endoscopy. because they found food in the stomach.
so i guess full stomachs you tube
so i guess full stomachs you tube
We do all the GI cases - haven't done nurse sedation in years.
Any time the scope goes down and there's still food in the stomach, it's a hard stop. Scope out - procedure is either aborted, or the pt gets an ETT. Food boluses are GA although we still get pushback.
Sedation nurse ambu bag.
Call for extubation. Or they can do it themselves….. [emoji57]
From the GI guys yes - "It'll just take me 2 minutes". You know how it is.
I would just do whatever is safe for the patient and what you are comfortable with. The gi doc is going to throw you under the bus if anything goes wrong.
Food impaction is an automatic intubation for me. They can literally take minutes or hours.
Food impaction is an automatic intubation for me. They can literally take minutes or hours.
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If I’m not comfortable and relaxed in endo suite, it’s because the patient is not safe and I know I made a bad decision. I hate being stressed and uncomfortable so I whenever there is a question, I make them wheel the endo cart to an OR, tube the patient, sit on the stool, and chill. Sometimes food impactions and UGIBs are 2 minute nothingburgers but I don’t care.
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As vague as this is, I have to agree. Anything impacted, unstable (septic, pressors, AMS, HgB under 7/recent transfusion) gets tube.
If the patient is in florid HF, or has bad bad COPD I tell them to optimize and come back another day.
I learned that more is more for these patients the hard way after awful, awful case.
