acute blood loss

Question 1

39 y.o. woman admitted to medical ward from GP surgery w 2 hour hx of vomiting fresh blood

pulse 120/min, BP 80/46, breathing satisfactory

(a) what are the most common causes of blood loss of this severity. suggest 3.

Answer 1

1. bleeding peptic ulcer
2. Mallory-Weiss tear
3. variceal bleeding

Question 2

as the FY, you take 20 mls of blood and request a cross match, blood count, electrolytes and clotting studies.

you also take a brief hx and perform a clinical exam.

(b) apart from the above, outline your initial mx of this pt in the first 15 mins of arrival on the ward. suggest 4.

Answer 2

• call the on-call surgeons/endoscopy team
• A: protect airway
• B: high-flow O2 through trauma mask, sats probe
• C: large bore IV access, urinary catheter, fluid resus ? O-neg blood, ABG, bloods:
  
  • ^{FBC: Hb and platelets}
  • ^{U+Es: increased urea}
  • ^{cross-match 4-6 units}
  • ^{LFTs: identify liver abnormalities (e.g. cirrhosis)}
  • ^{coag screen}
• other: CXR, ECG, NBM for endoscopy, IV omeprazole to reduce re-bleeding

Question 3

(c) when pt is stable, what monitoring instructions will you leave with the nurses? list 3.

Answer 3

1. BP, HR, UO
2. GCS
3. signs of re-bleeding