Procedural sedation gone wrong in patient with upper gastrointestinal hemorrhage

Scenario overview A 45-year-old man with history of hepatitis C and esophageal varices presented to ED with hematemesis. On team's arrival in room, patient is undergoing esophagogastroduodenoscopy (EGD) with propofol sedation all coordinated by the GI MD. Nurse calls to team saying she is concerned patient is oversedated due to decreased responsiveness and hypotension. Immediately GI MD will note acute hemorrhage occurring at varices. Increasing tachycardia and hypotension result. GI MD will refuse to stop procedure - “give me one more minute, almost there.” Team needs to force MD to stop procedure, manage airway with hematemesis and control hemorrhage. Blood products or Blakemore may be used. Teaching objectives/discussion points Clinical and medical management.