We were watching TNT tonight and "The Birthday Party" from S1 was on. During one of the traumas, a catcher's mit is put over the patient's face before a tube is entered into her esophogus (?). What is with that? I checked the episode guide but the medical commentary for that episode is not available.

-- Sharon (my3sonsand_done@hotmail.com), February 23, 2001

Answers

I'm not a doctor and I don't play one on TV, but from what I understood, the woman was an alcoholic and had bleeding vehr-ruh-SEEZ (blood vessles). The catchers mitt held in place an inflated tube that kept pressure on them and stopped the bleeding until surgeons could cauderize them.

Well, how close am I?

:) Jenna

-- Jenna (JennaLunt@aol.com), February 24, 2001.

That's what I figured. But don't you think that somewhere there's a medical device to do that? My hubby is a vet and he scooched forward in his chair and made a remark about how even in veterinary medicine they have more modern equipment!!

-- Sharon (my3sonsand_done@hotmail.com), February 24, 2001.

Jenna: You're right in what a catcher's mitt (also known as a Sengstaken tube) does; it uses two balloons, one in the esophageal lumen and one at the gastro-esophageal junction, to control bleeding from ruptured esophageal varices. (There's a third lumen in the tube as well, to evacuate gastric contents.)

There are a number of neat surgical tricks you can do in the OR, using an endoscope, to deal with variceal bleeding, but in an emergency-department setting the Sengstaken tube and drugs (vasopressors usually, sometimes a beta-blocker as well) are pretty much the standard of care. There really aren't any "advanced medical devices" you can use in an ED; they do exist, but they'd all be used by a gastroenterologist once the patient's been taken to surgery.

Esophageal varices themselves are caused by increased blood pressure in a specific segment of the circulatory system known as the portal circulation; increased pressure here (usually from cirrhotic liver damage, but sometimes also cancers and other chronic liver diseases, such as cystic fibrosis and hepatitis), can generate "mini-aneurysms" in the blood vessels feeding the esophagus. Those vessels rupture, and you get bleeding varices.

There's a great review of esophageal variceal disease, in great detail, available at the Memorial College of Newfoundland website; the link is posted here if anyone's interested. :)

http://calloso.m ed.mun.ca/surgery/esophval.htm

-- Lindsay E. Murphy (murphyl@earthlink.net), February 24, 2001.

But don't you think that somewhere there's a medical device to do that?

Sure there is, but you need to build it yourself. Do what I do (and what the manuals tell you to do) and tape three tongue boards together in a triangle, then tape the SK tube to the boards. Seriously. I've tried about six different designs and ideas for securing these things, and it really doesn't get any better than that. A catcher's mask would work well, but we're too cheap to buy one.

Yep, no better way to make patients feel at ease than to do a little MacGuyver-style improvisation. Next week I'll explain how you can avoid budget cuts and assemble your own defibrillator using a 9 volt battery, two paperclips, and some Grape Hubba-Bubba. Don't miss it!

-- Mike Sugimoto (phloem@fumbling.com), February 24, 2001.

My husband replies: I was told a story about an old DVM whose office was under his house in Brooklyn. When he did and end to end anastomosis of the small intestines (sewing two ends of intestine back together), he would shout up to his wife to bring down the rigatoni pasta. He would instert this into the ends covering the rigatoni and use the grooves as guides for suturing. The rigatoni isn't sterile but neither is the intestine. It eventually digests! Picture that scenario. "Hey Martha, bring down the pasta now".

-- Sharon (my3sonsand_done@hotmail.com), February 25, 2001.