Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Gastrointestinal Bleeding

Video Transcription

Video Summary

The session discusses gastrointestinal (GI) bleeding and hepatic failure. The initial case involves a 75-year-old patient with hematemesis, hypotension, and tachycardia. Peripheral IV access with crystalloids is recommended over PRBC for initial resuscitation. For transfusion, a restrictive strategy with a hemoglobin goal of 7 is preferred. Peptic ulcer disease is the most common cause of upper GI bleed, with endoscopic therapy reducing re-bleed risk. Various risk stratification scores like Glasgow Blatchford and AIM-65 guide treatment locations. The patient with GI bleed and on apixaban should resume anticoagulation within two weeks if high-risk factors are absent. For lower GI bleeds, colonoscopy with epinephrine injection and cautery is standard. In variceal bleeds, antibiotics, octreotide, and early endoscopy improve outcomes. Tips are recommended after two failed EGD attempts for re-bleeding, with contraindications including high MELD scores and venous thrombosis.

Keywords

gastrointestinal bleeding

hepatic failure

peptic ulcer disease

risk stratification

endoscopic therapy

variceal bleeds

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