Last night was non-stop crisis intervention, it seemed. After two new admissions, the remainder of the unit seemed to do nothing but bleed. We were ordering blood replacements on at least four patients, maybe five. In most cases, we had and still have no idea where the blood was going.

A middle aged man had developed a DVT (deep venous thrombosis) while spending a prolonged amount of time in the hosptial for complications related to his gall bladder surgery. After becoming short of breath, he was started on heparin, a blood thinner, to help prevent additional clots from moving to his lungs. Several hours later he coded. He was blue, unconscious and had no blood pressure. A code was called overhead, residents rushed in, placed a large diameter ‘introducer’ catheter into a large leg vein, started pouring in normal saline. Meanwhile his hemoglobin was 4.5 (normal hemoglobin is around 14), so they pour several units of blood in as well and he was moved to the ICU. Later that morning, he was awake and had no recollection of the incident. We had teh gastroenterologists do an endoscopic exam of his esophagus, stomach and duodenum, and what they found was frightening. A lake of blood sat in his stomach, and an exposed vein bulged from the wall of his espohagus. The vein was injected with epinephrine to shrink the vessels and then cauterized. Nevertheless, the attending made it clear to us, that if it should start to rebleed, he would soon be dead unless we took quick action. We had a minnesota and a blakemore tube at the bedside ready to insert into his esophagus and inflate the balloon to apply direct pressure to teh bleeding site. Thankfully, it was unneeded last night. They returned today to see if they could visualize the rest of the stomach and see if there were additional bleeding sites.