Massive Upper Gastrointestinal Bleeding

Area of Science:

• Medical Education
• Emergency Medicine
• Simulation Training

Background:

• Upper gastrointestinal bleeding (UGIB) presents significant management challenges in emergency departments.
• Specific difficulties include massive bleeding, airway compromise, and patient refusal of blood products (e.g., Jehovah's Witnesses).

Purpose of the Study:

• To evaluate a high-fidelity simulation for training emergency medicine residents in managing complex UGIB scenarios.
• To improve residents' skills in airway management, balloon tamponade placement, and alternative therapies for non-blood-product patients.

Main Methods:

• A high-fidelity simulation incorporating a modified mannequin for airway contamination was used.
• Emergency medicine residents participated in simulated encounters, with others observing and debriefing remotely due to COVID-19.

Main Results:

• Residents reported the simulation was realistic, complex, and improved medical knowledge and procedural skills.
• Key learning areas included managing UGIB in Jehovah's Witnesses and placing a gastroesophageal balloon tamponade device.

Conclusions:

• This reproducible simulation effectively trains emergency medicine residents in managing life-threatening UGIB.
• The case highlights and addresses critical knowledge and skill gaps in managing challenging gastrointestinal hemorrhage scenarios.