Acute Variceal Bleed (GI Bleed Part 3/3)
Medgeeks with Andrew Reid
Medgeeks
4.8 • 997 Ratings
🗓️ 28 June 2018
⏱️ 9 minutes
🧾️ Download transcript
Summary
You're on the rapid response team and are called over to a patient presenting with hypotension.
Per nursing, the patient is a 58 year old male with a PMH of:
- ETOH abuse (1 pint of vodka daily)
- Cirrhosis
While in the room, the patient vomits a large amount of bright red blood, followed by a drop in the systolic blood pressure to the 70s.
The patient looks lethargic, unresponsive to verbal stimuli or a sternal rub. You see fresh blood in the oropharynx.
What should you do next?
We'll walk you through and answer that for you in today's podcast.
p.s. this is part 3 of 3 for the GI bleed lecture series. Next week, we'll tackle a brand new topic.
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Transcript
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| 0:00.0 | Team, Zach Laviner here for med geeks. |
| 0:04.0 | Finally, the scary liver patient who has a GI bleed. |
| 0:08.0 | I'm sure you're all really probably thinking, thank God it's the last G.I. |
| 0:11.0 | Bleed lecture, but have a listen because the day you have a liver |
| 0:15.0 | patient with a G.I. bleed, you'll thank yourself you listen to this podcast. |
| 0:19.7 | So as always, a little background evaluation and management as we go through a case. |
| 0:24.9 | Also I'm going to hit the pause button a few times during this case and say go. |
| 0:29.9 | At that point I want you to tell yourself in your head what would you do next in the situation? |
| 0:34.9 | This will force you to kind of think aloud. |
| 0:38.0 | So you're on a rapid response team, you get called overhead to a patient with hypotension. Per nursing the patient's a |
| 0:44.9 | 58 year old male with past medical history of ETOH abuse, drinks about one |
| 0:50.0 | pine of vodka daily, and has a history of cirrhosis. They vomited a large amount of bright red blood in the room, followed by a drop in the patient's |
| 0:58.4 | systemic blood pressure to the 70s, and that's what prompted the rapid response call. |
| 1:03.0 | As you look at the patient quickly, you notice right away that the patient's lethargic, |
| 1:08.0 | unresponsive to verbal stimuli. |
| 1:11.0 | You give the patient a nice external rub and you get really no response either. |
| 1:15.6 | You take a quick look at the patient's airway and you notice some fresh blood is in the patient's |
| 1:19.8 | oral varings. |
| 1:21.4 | So let's stop and think for a moment what should you do next. Go. |
| 1:25.0 | Okay so let's see if you're right. Given the fact that the patient is altered and |
| 1:31.8 | not protecting their airways due to that blood puts them at |
| 1:35.2 | high risk for aspiration. So you quickly call overhead for anesthesia for intubation. |
... |
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