Mackenzie Hawk

Mucci Friday Pro 2 Clinical

November 7, 2019

Endoscopy Report
During my endoscopy rotation, I was able to sit in on a handful of interesting cases

throughout the day following a few different doctors and nurses. In one room, they had lined up

multiple esophagogastroduodenoscopy ultrasounds with one of the doctors, which happened to

be a new procedure to St. Elizabeth’s Main Campus. When I observed, the nurse in charge

informed me that they had only performed two other of this type of procedure thus far, and they

had special representatives from the equipment manufacturing company come in to help assist.

This was very helpful to the staff since they had not been previously trained on how to operate

the machinery.

The case I chose to elaborate on was actually performed on one of the same patients that I

was able to observe surgery on the week before. Prior to the procedure, she had come to the

hospital exhibiting signs of dysphagia and possible aspiration as a complication. Since being in

the hospital, she had started to not eat or tolerate her foods. Because of this, the doctor has

ordered an esophagogastroduodenoscopy with Botox injection and percutaneous endoscopic

gastrostomy tube insertion. The patient had been NPO for 8 hours prior, and only given her

pertinent medications. They started the procedure by introducing the patient to all of the team

members, and the anesthesiologist examined the patient to help anticipate any potential

ENDOSCOPY REPORT 1

complications of the airway during the procedure. After this, the nurse placed a plastic device in

the patient’s mouth to prevent her from accidentally biting down on the scope during the

procedure. This helped to protect the patient’s dentition and the equipment. Next, the patient was

given a sedative and monitored while going to sleep. Once the patient was properly sedated, the

team positioned the patient on her left side, and the scope was lubricated before inserting it into

her esophagus. A copious amount of old, undigested food was found in the esophagus, which

solidified the previous suspicion of dysphagia. However, after the food was removed, the

patient’s airway became compromised. Her oxygen saturation dipped down into the forties, and

the doctor had to pause the procedure until the patient was stabilized. After some suctioning and

bagging, they restored her oxygen levels and continued the procedure. The doctor injected Botox

into the smooth muscle of the esophagus so that it would relax and make it easier for the patient

to swallow food when her diet was advanced. Next, the doctor percussed on the patient’s

abdomen directly above where the scope was inside the stomach and made an incision to insert

the gastrostomy tube.

In order to advocate for the patient’s safety, the nurse directed a “time out” at the beginning

of the procedure that consisted of a briefing to ensure that the right procedure with the right

doctor was being performed on the right patient. It also consisted of any allergies the patient had,

and any special considerations that needed to be addressed. The communication was fluid in the

room for the most part, besides when people started to panic as a result of the compromised

airway. The CRNA’s remained mostly calm while fixing the issue, but the nurse had to find all

the necessary equipment that the doctor was requesting. All in all, the nurse did the best job of

maintaining patient safety and directing the course of the procedure.

ENDOSCOPY REPORT 2