Team Welcome back.

Zach Lavender here from Metgeeks.

Last week we talked about the acute upper GI Bleeder.

This week we're going to focus on the acute lower GI bleeder.

As always, we will talk about some background, evaluation, and management while we go through a case.

So you have a 60-year-old male with a past medical history of osteoarthritis, COPD with a 20-pack year history of smoking,

persistent atrial fibrillation on warfarin,

hypertension, hyperlipidemia, diverticulosis, and rectal cancer. The patient comes in one day and rectal cancer.

The patient comes in one day of rectal bleeding causing them to spend the whole day in the bathroom,

roughly having about bleeding episodes every hour.

They don't have any issues this morning and deny any

associated symptoms. However, they've had similar episode like this years ago.

So they said, you know, let's go into the emergency department for a little further evaluation.

So as we do with the acute upper GI Blader, we want to quickly scan the chart and talk to the nurse

about a few important things before we head into the room.

One, what is the trend of the patient's blood pressure since arrival to the emergency department?

Remember, we don't care about one blood pressure, unless obviously it's in the toilet, but it's all about the trend.

Two, is the patient actively bleeding and are they symptomatic, aka do they feel weak, lightheaded, when they stand up do they feel dizzy? Are they pale in color?

Three, what is the access access access? Remember, those big 18 gaugers are important.

So our patients, blood pressure, and heart rate have been stable over the past few hours since arrival in the 120s,

1.30s, and heart rates have been in the 80s.

The patient hasn't had any bloody bowel moment since arrival and remains

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