Principles of Bleeds

Question 1

5 Principles when managing bleed

Answer 1

1. Hemodynamic stability - clinically significant bleeds will cause change in postural blood pressure and tachycardia, HGB will not fall immediately, if the HGB has fallen this means that the patient has been bleeding for about 72 hours as the extravascular fluid enters the vascular space.
2. Access - 2 large bore IV’s, pulmonary artery catheter
3. Correct coagulation - Vitamin K, octreotide, PPI
4. Transfusions - closer to 90 patients who have been bleeding
5. Scope

Question 2

Medications

Answer 2

Acid suppression - PPI
Prokinetics - erythromycin, metaclopramide
Somatostatin and Octreotide
Antibiotic prophylaxis (SBP) for patients with cirrhosis hospitalized for GI bleed

Question 3

DDx for BRBPR

Answer 3

Colitis
Diverticulosis
Angiodysplasia

Question 4

Blood products

Answer 4

Universal plasma donor - type AB

Universal packed cell donor - type O

Question 5

Common causes of acute rectal bleed

Answer 5

Diverticulosis
Vascular malformations
Neoplasm

Question 6

Arteriography

Answer 6

Helps make the diagnosis and control the bleeding

Question 7

Pseudoanuerysm in acute pancreatitis

Answer 7

1. Splenic artery - Left side
2. Gastroduodenal artery - R side
3. Pancreatioduodenal

Question 8

Management of Variceal bleed

Answer 8

Upper endoscopy
TIPS (Transjugular intrahepatic portosystemic shunt)
Surgical portosystemic shunt
Meds - B-blockers