Management of the Massive GI Bleed

A brief summary of the initial emergency department resuscitation of a patient with massive gastrointestinal bleeding

Case

You are called urgently to resuscitation. Walking into the room, you recognize a familiar face. In fact, didn’t you discharge him home yesterday with epigastric pain that you attributed to his chronic alcohol use? Today’s diagnosis is not a mystery. There is already a puddle of blood on the floor, and he is quickly filling another emesis basin with bright red blood. A glance at the monitor reveals a heart rate of 135 and a blood pressure of 74/34…

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Balloon tamponade of massive GI bleeding

A brief summary of the procedure of balloon tamponade in massive upper gastrointestinal haemorrhage

Case

You have been resuscitating the 62 year old man with a massive GI bleed from the previous post. You started your massive transfusion protocol and have him safely intubated. However, he continues to bleed, and you need to transfer him out of your small community hospital…

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Management of postpartum hemorrhage in the emergency department

Case

It has been a busy day in your emergency department. The precipitous delivery that occurred at triage was complicated by shoulder dystocia. Luckily you had some help, and one of your colleagues is managing the neonatal resuscitation. Nurses are starting to congratulate mom and pat you on the back, when a senior nurse points out that the patient looks pretty pale. You glance at the monitor and notice a heart rate of 145 and only then do you notice that she is bleeding… a lot…

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The bleeding tracheostomy

Managing acute hemorrhage from a tracheostomy

Case

On another shift, the 45 year old man with a tracheostomy from the prior case is brought back into the emergency room. This time, he is actively bleeding from his tracheostomy site…

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Massive Hemoptysis

A simplified approach to the initial assessment and management of emergency department patients with massive hemoptysis

Case

The charge nurse grabs your arm and pulls you into the resuscitation bay, where EMS have just unloaded a 45 year old guy in obvious distress, coughing up a significant amount of blood. The paramedic tells you, “He doesn’t speak English, so we don’t know a lot about him. My guess is that he has already coughed up about 250ml of blood on route. He still sating OK, and his pressure is holding, but I’m just glad we got here. He’s all yours doc…”

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