Clinical 6.3 Bleeding and the deteriorating patient

Question 1

What is meant be the deteriorating patient?

Answer 1

Critical illness (organ dysfunction/failure) duet to inadequate oxygen getting to cells/tissues/organs

Question 2

What is the equation for oxygen delivery?

Answer 2

(SV x HR) x ([Hb] x SaO2 x 1.39) + PaO2 x o.oo3 ut (L/min)

Question 3

What are the clinical signs of GI haemorrhage?

Answer 3

Pale: decrease in Hb = increase in TPR

Tachycardia: decrease in Hb = decrease in SV

Hypotension/postural hypotension: decrease in CO from decrease in SV

Cool peripherally: increase in peripheral resistance from decrease in CO

Sweating: sympathetic response to increase TPR, increase contractility of myocardium and increase chonotropy

Confusion/loss of consciousness: sign of end organ function

Oliguria/anuria: end organ function

Question 4

What are the causes of GI haemorrhage?

Answer 4

peptic ulceration, oesophagitis, variceal, malignancy, coagulopathy

Question 5

What are the causes of lower GI bleeding?

Answer 5

Diverticulitis, IBD, malignancy, coagulopathy

Question 6

What are the clinical signs of lower GI bleeding?

Answer 6

Loss of Hb and circulating volume and bright red per rectum

Question 7

What indicates blood loss of <15%

Answer 7

no abnormality or resting tachycardia alone

Question 8

What indicates blood loss >15%?

Answer 8

a fall in BP >20mmHg or increase in HR >20

Question 9

What indicates blood loss >40%?

Answer 9

supine hypotension