PR bleeding!!!
laparotomy - 01-27-08 08:15 Bookmark and Share

A 95 year old female presents to your emergency department with a history of 3 episodes of massive PR bleeding and hematemesis. On arrival her blood pressure is 130/85. 1 hour later her blood pressure drops to 93/75 pulse 93. Labs are taken and show a Hb of 9.3.

What is your next step in management?

I am sorry for not putting options like A, B, C etc. This is because I would like us to have a discussion and not simply a reply like C. I think this approach will strenghten our knowlage.

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#1
Re: PR bleeding!!!
8401glacieres - 01-27-08 09:33

Haematamesis(50%) and melena(80%) are most common presentations of UGI bleed.
Haematamesis almost certainl signifies upper GI bleed unlike melena which is possible both in UGI & LGI bleeds.

Poor prognostic indicators in UGI bleed are
1)age >60,
2) ststolic blood pressure of

#2
Re: PR bleeding!!!
8401glacieres - 01-27-08 09:41

Sorry lot of text is missing in my reply, here we go,,,,,,,,,,,,
2) systolic BP less that 90
3)HR>100
4) ongoing hypovolumic shock

Management
1) stabalise the patient, schedule emergent upperGI endoscopy
2) TWO attempts of treating the patient with endoscopy should be made if not,surgery should be considered.
3)Surgey in a 95yrs old lady can be done, provided she does not have any of the contraindications which is byitself a big list-IMPORTANT among them is absence of cirrhosis and it's complications, no hist of MI within previous 6 months, pt not in heart failure.

#3
Re: PR bleeding!!!
laparotomy - 01-27-08 14:10

I think a history of MI, cirrhosis on its own is not a contraindication for surgery

#4
Re: PR bleeding!!!
radhamesramos - 01-28-08 11:58

those are not contraidications if it is a bleeding emergency

#5
Re: PR bleeding!!!
laparotomy - 01-28-08 15:13

posted by radhamesramos on 01-28-08 11:58

those are not contraidications if it is a bleeding emergency



Exactly

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