ISBAR GI bleed Final,Patient
most common emergency of the GI tract - ANSWER: GI bleeding
mortalilty risk for GI bleed - ANSWER: 10%
factors that affect mortality - ANSWER: cardio-pulmonary disease
cancer
liver disease
ACUTE GI BLEEDING - ABC's of management - ANSWER: A-Airway
B-Breathing : Assess need to be intubated
C-Circulation- Assess hemodynamic stability
*NGT Lavage:* assess for an upper GI bleed
*Labs:* CBC, Electrolytes, Liver Function Tests, PT & PTT, Type & Cross
*History: * Assess risk factors for the different types of GI bleeding
4 main categories of G.I. bleeding - ANSWER: 1. Upper G.I. tract → esophagus,
stomach, proximal small bowel
2. lower G.I. tract → colon
3. occult G.I. bleed → patient unaware they are bleeding, but may see evidence with
an iron deficiency, anemia or guaiac + stools
4. obscure G.I. bleed → bleeding is obvious to the patient and the clinician, but
unable to identify the source
Ratio of upper G.I. bleeding to lower G.I. bleeding - ANSWER: 5:1
4 fundamental clinical principles that apply to G.I. bleeds - ANSWER: 1. Immediate
assessment and stabilization of the patient's hemodynamic status
2. careful history and physical exam
3. prediction of the etiology/source of bleeding
4. specific investigation to delineate the source of bleeding and apply proper therapy
(upper endoscopy, colonoscopy, angiography)
Labs that should be ordered for suspected G.I. bleed - ANSWER: CBC
electrolytes
liver function tests
PT and PTT
crossing type for PRBC
Signs of G.I. bleeding - ANSWER: -Hematemesis
-melena
-hematochezia
-frequent stools-brown stool
, Hematemesis and/or melena - ANSWER: Usually upper G.I. bleed
-rarely melena can mean a bleed from the right:
Melena - ANSWER: Dark, tarry stools due to digested blood products in the G.I. tract
-slow source from the *right side of the colon*
Hematemesis - ANSWER: Vomiting blood
Hematochezia - ANSWER: Lower G.I. source
-rarely can be a brisk upper G.I. bleed
*bright red blood with or without stool, maroon-colored stool, or passage of blood
clots per rectum*
Interpretation of increased frequency stooling - ANSWER: More active bleed
Interpretation of vital signs - ANSWER: Normal → percent blood loss <10% → bleed
type = mild
orthostatic hypertension or tachycardia → percent blood loss between 10 and 20%
→ bleed type = moderate
shock → percent blood loss 20-25% → bleed type = massive
Hematocrit goals - ANSWER: -for elderly patients with known coronary artery disease
→ aim for >30
-for younger patients who are otherwise healthy → aim for Hct 23-25
-take into account other comorbidities such as COPD/congestive heart failure
Reasons to give fresh frozen plasma - ANSWER: -To normalize the INR
-patient on ASA and Plavix
Patient history of chronic NSAID use - ANSWER: risk for gastritis, gastric ulcers,
duodenal ulcers
Patient history of underlying liver disease - ANSWER: raises concern for variceal
bleeding and portal gastropathy
Patient history of diverticulosis - ANSWER: think diverticular bleed
History of abdominal aortic aneurysm repair - ANSWER: aortoenteric fistula
Patient history of unexplained weight loss - ANSWER: Malignancy
suspicion of chronic alcohol abuse - ANSWER: Suspect underlying liver disease so →
raises concern for variceal bleeding and portal gastropathy
most common emergency of the GI tract - ANSWER: GI bleeding
mortalilty risk for GI bleed - ANSWER: 10%
factors that affect mortality - ANSWER: cardio-pulmonary disease
cancer
liver disease
ACUTE GI BLEEDING - ABC's of management - ANSWER: A-Airway
B-Breathing : Assess need to be intubated
C-Circulation- Assess hemodynamic stability
*NGT Lavage:* assess for an upper GI bleed
*Labs:* CBC, Electrolytes, Liver Function Tests, PT & PTT, Type & Cross
*History: * Assess risk factors for the different types of GI bleeding
4 main categories of G.I. bleeding - ANSWER: 1. Upper G.I. tract → esophagus,
stomach, proximal small bowel
2. lower G.I. tract → colon
3. occult G.I. bleed → patient unaware they are bleeding, but may see evidence with
an iron deficiency, anemia or guaiac + stools
4. obscure G.I. bleed → bleeding is obvious to the patient and the clinician, but
unable to identify the source
Ratio of upper G.I. bleeding to lower G.I. bleeding - ANSWER: 5:1
4 fundamental clinical principles that apply to G.I. bleeds - ANSWER: 1. Immediate
assessment and stabilization of the patient's hemodynamic status
2. careful history and physical exam
3. prediction of the etiology/source of bleeding
4. specific investigation to delineate the source of bleeding and apply proper therapy
(upper endoscopy, colonoscopy, angiography)
Labs that should be ordered for suspected G.I. bleed - ANSWER: CBC
electrolytes
liver function tests
PT and PTT
crossing type for PRBC
Signs of G.I. bleeding - ANSWER: -Hematemesis
-melena
-hematochezia
-frequent stools-brown stool
, Hematemesis and/or melena - ANSWER: Usually upper G.I. bleed
-rarely melena can mean a bleed from the right:
Melena - ANSWER: Dark, tarry stools due to digested blood products in the G.I. tract
-slow source from the *right side of the colon*
Hematemesis - ANSWER: Vomiting blood
Hematochezia - ANSWER: Lower G.I. source
-rarely can be a brisk upper G.I. bleed
*bright red blood with or without stool, maroon-colored stool, or passage of blood
clots per rectum*
Interpretation of increased frequency stooling - ANSWER: More active bleed
Interpretation of vital signs - ANSWER: Normal → percent blood loss <10% → bleed
type = mild
orthostatic hypertension or tachycardia → percent blood loss between 10 and 20%
→ bleed type = moderate
shock → percent blood loss 20-25% → bleed type = massive
Hematocrit goals - ANSWER: -for elderly patients with known coronary artery disease
→ aim for >30
-for younger patients who are otherwise healthy → aim for Hct 23-25
-take into account other comorbidities such as COPD/congestive heart failure
Reasons to give fresh frozen plasma - ANSWER: -To normalize the INR
-patient on ASA and Plavix
Patient history of chronic NSAID use - ANSWER: risk for gastritis, gastric ulcers,
duodenal ulcers
Patient history of underlying liver disease - ANSWER: raises concern for variceal
bleeding and portal gastropathy
Patient history of diverticulosis - ANSWER: think diverticular bleed
History of abdominal aortic aneurysm repair - ANSWER: aortoenteric fistula
Patient history of unexplained weight loss - ANSWER: Malignancy
suspicion of chronic alcohol abuse - ANSWER: Suspect underlying liver disease so →
raises concern for variceal bleeding and portal gastropathy
