Wednesday Wrap-up: 3/14/12

by mritchie • March 3, 2012 • 3 Comments

Welcome to Wednesday Wrap-up!

Each week after conference the TOKC Blog team will post a follow up to a lecture or discussion point that came up during conference so that those who were there can continue the conversation and those who missed out can join in. All you need to do to participate is register with the blog and post your comments.

During the M&M conference this morning, a case of a lower GI bleed was presented. Don’t worry, I won’t mention any of the details, but I have recently had several cases of varying severity and was curious how everyone deals with the management of these patients. Everyone knows if you talk to internal medicine and surgery about this topic, you will get two very different responses. Initial management begins with the ABC’s and establishing IV access. That means two large bore IV’s and/or cental access if necessary. Typically you will begin resuscitation with crystalloid but switch to PRBCs quickly if necessary. Resuscitation needs to be agressive with these patients as they can decompensate fast. These patients will also require continuous monitoring and frequent hematocrits as it is not always obvious how much bleeding is occurring. But my question is what is your algorithm for identifying the source of bleeding? Colonoscopy, angiography, nuclear medicine scan? What are your criteria for calling surgery or critical care? I personally am generally calling both GI and surgery if my patient has any risk factors such as advanced age, gross blood on rectal exam, abnormal vital signs, or taking anticoagulants. And how do you deal with the medicine vs surgery conflict with regard to final disposition. Weren’t we all taught that LGIB’s should be admitted to surgery? The last point I wanted to raise was the use of platelets and DDAVP in patients on ASA or plavix. Under what circumstances are you using these agents?

Please post your thoughts below as I would really like to hear from both the faculty and residents on how you are dealing with these issues.

Thanks for reading,

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.