Massive variceal bleed and no EGD at your hospital?

Be ready to place a blakemore/balloon tamponade device in uncontrolled variceal hemorrhage.

Tips from prior cases

#foamcc
#foammed

After ABC's...

1. Place the device like an OG

2. Check position by xray (may need little air ~50 ml in balloon to see)

3. Inflate gastric balloon with ~ 250 mL air

4. X ray

Don't over inflate

👇

Image: overinflated and improperly positioned causing gastric distension 😯

Deflated & repositioned w/ balloon at the GE junction to tamponade the variceal origins

Apply light traction w/ kerlix->IV pull->1 L fluid

Use esophageal balloon only if gastric doesn't control bleed-more complication risk w/ esoph balloon must use manometer (ET tube cuff manometer works convert cm H20 to mm Hg) & keep balloon pressure < 30-45 mmHg