Critical Care Time 54. Non-Variceal GI Bleeds
Jul 28, 2025
In this discussion, Dr. David T. Dulaney, a distinguished gastroenterologist and fellowship program director in San Antonio, delves into the intricacies of non-variceal GI bleeds. He explains the crucial role of patient stabilization before interventions, highlights the effectiveness of the Glasgow Blatchford score for assessment, and underscores the importance of teamwork among healthcare professionals during crises. The episode also explores unique challenges in managing elderly patients and emphasizes the value of timely interventions and personalized care strategies in achieving optimal outcomes.
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Early Scope Saved Patient's Life
- David Dulaney shares the story of a critically ill patient with massive upper GI bleeding who was stabilized by early endoscopy and then successfully treated with interventional radiology.
- This case highlights the importance of timely intervention even in unstable patients to improve outcomes.
Use Glasgow Blatchford Score
- Use the Glasgow Blatchford Score (GBS) to risk stratify upper GI bleeds, as it has highest sensitivity for identifying patients needing admission.
- Always combine decision tools with clinical assessment; never discharge patients solely based on scores.
High BUN-Creatinine Reflects GI Bleed
- Elevated BUN-creatinine ratio (>30:1) suggests gastrointestinal blood digestion, not just pre-renal azotemia.
- Monitor BUN trends to help identify active GI bleeding and guide clinical evaluation.