The Internet Book of Critical Care Podcast IBCC Episode 3 - Approach to the GI Bleed
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Sep 19, 2018 A practical tour through upper and lower GI bleeding, from spotting early signs of instability to choosing blood products without overdoing it. The discussion covers cirrhosis and variceal bleeding, when CT angiography can pinpoint the source, and how interventional radiology fits into the search for bleeding that needs control.
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Signs of Bleeding
- Assess bleeding signs by considering hematemesis volume and melena/hematochezia quantity. Absence of bowel movements may indicate a non-active bleed.
Lab Tests
- In addition to basic labs, consider checking fibrinogen, especially in cirrhotic patients. INR can be unreliable in cirrhosis due to rebalanced hemostasis.
Vascular Access
- Secure two large-bore peripheral IVs initially. For massive bleeds or anticipated massive transfusions, establish central access, preferably a large-bore hemodialysis catheter.