110 GI bleeds or Gastrointestinal Hemorrhage

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4.6 • 665 Ratings

🗓️ 10 April 2023

⏱️ 28 minutes

🔗️ Recording | iTunes | RSS

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Summary

Join Dr. Mike Wallace and Dan McCollum as they discuss the management of patients with gastrointestinal hemorrhage.

What is the initial management of these patients?
Who requires blood transfusions?
Which patients require admission to the floor or the ICU?

Pearls and pitfalls in the management of these challenging patients are discussed. Enjoy!

Transcript

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0:00.0	Hey, this is Dan McCollum, and today I am joined by an awesome resident here in Augusta named Mike Wallace,
0:06.0	who's going to be discussing with us how to approach the patient with a GI bleed.
0:11.2	Hey, Dr. McCollum, good to be here and excited to talk about GI bleeds with you today.
0:15.9	So we want to go ahead and have a disclaimer.
0:17.9	The views of Mike and myself do not represent the U.S.
0:25.0	military, August University, or anybody else. It's just two guys trying to educate you about GI bleeds. So let's go ahead and launch into a case. So you're working in the emergency
0:31.3	department and you have a 65-year-old gentleman. He has a history of hypertension, hyperlipidemia,
0:37.0	and coronary artery disease,
0:38.8	coming in with a chief complaint of red slash maroon colored bowel movements over the last 48 hours.
0:44.6	When you walk into the room, he's alert and oriented and non-toxic appearing.
0:49.2	What are some parts of the history and physical exam that may help you guide your disposition and
0:53.6	management? All right. So it's going to segue right into the history and physical exam that may help you guide your disposition and management.
0:59.1	All right. So it's going to segue right into the history of present illness. So let's discuss a little bit about this. So one thing that would definitely be looking at would be the duration of the
1:03.3	symptoms. And what exactly is the amount of blood loss? A lot of patients struggle to actually say
1:09.2	exactly how much blood is gone. And they'll often over-exaggerate
1:12.9	the exact amount. For example, a few drops of blood in the toilet might make the entire bowl appear red.
1:18.7	However, some patients truly have lost a large amount of blood, so specify exactly what they saw
1:23.8	and exactly what color it was, particularly what shade of red or black, can be very
1:27.5	helpful. And one important part of the history is trying to focus in on, does it sound like
1:33.1	it's an upper GI bleeding source or is it a lower GI bleeding source? And that's important for a number
1:39.0	of reasons. One is it really guides your intervention and it guides your specialist intervention.
1:45.1	It can also give you an idea on how sick or high risk this patient may be.
	...

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