MDSO GI/GU

Question 1

MDSO : NV and Motion Sickness:

Contraindications

Answer 1

Allergy
Gavol (dimenhyDRINATE)or Zofran (Ondansetron) in the last 4 hrs
Prologued QT or other drugs that cause long QT if considering Zofran

Question 2

MDSO NV and Motion Sickness

Drug, Doses, Patch, Considerations

Answer 2

1) Gravol : 50 mg IM/PO or 50mg/10 mL - slow push to prevent vertigo, weakness and dizziness

2) Zofran: 4 mg IM q 4-8 hrs PRN or 4 mg in 50 mL > 15 min q 4-8 hrs

Question 3

Gravol vs Zofran

Which for Motion ? Pregnancy ?

Answer 3

Gravol: H1 ; best for NV due to Sx, Pregnancy and Motion Sickness

Zofran: 5-HT3 - Serotonin R - risk of Seretonin Syndrome - best for Chemo NV

Question 4

MDSO: GI Bleed

Tx: Drugs, Dose, Targets, Patch, Considerations

Answer 4

1) NS - 20cc/kg
2) Consider Blood
3) Can continue Pantoprazole and / or Octreotide without patch, but must patch to initiate:
- Pantoprazole (MP) - Bolus 80 mg IV , followed by 8mg/hr
- Octreotide (MP) - Bolus 50 mcg > 3 min , followed by 50 mcg/hr IV

• Consider Ceftriaxone 1 g (1 g powder into 9.6 mL THEN over 3-5 min OR put the 10 mL into 50 > 15 min)
  ——or other option 1 g in 2.2 mL NS and IM into deep muscle.
  **consider MD for Blakemore Tube (1 L NS as counter weight) - Esophageal Balloon inflated to 25-45 mmHg or 35-60 cmH20….patient should be intubated and sedated to increase patient tolerance and comfort…you want 1 kg of traction….
  ** it’s possible to not intubate - scissors should be available to cut port for balloon deflation in case balloon ends up occluding the hypopharyngeal occlusion
  Can as MD for Clip…

also consider Anticoag Reversal.

Question 5

MDSO GI Bleed.

Is the Treatment for UGIB or LGIB ?

Answer 5

It’s for UGIB

Question 6

Upper GI vs Lower GI Signs ?

Upper GI vs Lower GI Patho ?

Answer 6

UPPER: Hematemesis, “Coffee Ground”, Melina (dark, tarry, fouls smell
- d/t damage of upper GI - GERD/ULCERS/TUMORS/VARICES and disorders like Mallory-Weiss Tears (tear of lower esophagus caused by violent coughing or vomiting)
- increased risk in HEMOPHELIA AND THROMBOCYTOPENIA
-c/o abdo pain, indigestion, vomiting blood……could lead to hypotension , anemia, shock

LOWER: Hematochezia (fresh blood in feces - red/maroon)
Rule out Upper GI Bleed with “rapid transit” - hemodynamics impacted ? Treat as above
> 50 % Lower GI - Diverticulitis
Also colitis, hemmroids, Colorectal Cancer

Question 7

Pantoprazole and Octreotide - MOA

Answer 7

Octreotide - splashing vasoconstrictor

Pantoprazole: - PPI

Question 8

GI Bleed - ETT considerations (from Flowchart)

Answer 8

USE SALAD 0 2 x suction
High Risk d/t Blood if Upper GI Bleed
Intubate in incline position to limit blood pooling
SALAD = Suction Assisted Laparoscopy Airway Decontamination

Question 9

Blakemore Tube Proceedure: You Tube.

Answer 9

https://youtu.be/NHelCd5Jtp4

Placement of a Blakemore Tube for Bleeding Varices (4:47)