There’s a lot of things to like about being an Emergency Physician: the hours, the healthy sarcasm and joke-cracking during a shift, acute pathology, procedures, helping patients; and there’s a lot of things to dislike about being an Emergency Physician, too (you can name your own).
But there’s one thing medically that I can’t stand more than anything else: the NG lavage for upper (or “undifferentiated”) GI bleeds. To me, there’s really no worse test, and here are my reasons:
- It’s a poor screening test. We’re looking for the presence of blood in the stomach. Screening tests should have a high sensitivity, since you want to rule-out disease. And NG lavage simply doesn’t. It has tons of false negatives and tons of false positives.
- It’s brutal. The adage is that we do no other procedure without sedation that is more uncomfortable than the NG tube placement.
- It doesn’t change my management or practice. I find that if patients are continuing to have an active upper GI bleed, I know it by looking at them and their vital signs. They are persistently tachycardic. They are diaphoretic. They pass large clots or melenic stool. They vomit bright red blood or coffee grounds.
Similarly, if a stable, well-appearing patient is pooping bright red blood, odds are it’s probably a lower GI bleed. Have I seen a massive upper GI bleed present as just lower GI bleeding? Yes, in an unstable, tachycardic, hypotensive demented 85 year old woman.
I’m hoping I’m not the only one here who feels this way–but I wonder what’s the bee in the bonnet for everyone else? The CT/LP for subarachnoid? New left bundles with no prior EKG? Renal failure who desperately really needs a CT scan? Looking forward to your thoughts on the NG tube or any other acronym that drives you
to drink mad during a shift.