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  #1  
Old 06-02-2014
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Default Hematochezia, GI Bleeding Next best steps

Hey everyone,

So just wanted to confirm this troubling accept of the next immediate best steps. Kaplan says something else, while UW says a different strategy. Here is a flow chart of what I think the workup should be.

1. Irrespective, the first steps are always stabilization : Large bore needles, Type and crossmatch, Correct coagulation/FFP/Plts as needed
2. Here is where my problem comes up:

-kaplan says to put an NG tube and see if the blood is coming from above. If the NG tube shows green bile, you can be sure its not from up. Or if it returned clear fluid, you still have to do an Upper Endo since that means the tube never reached beyond pylorus and there may still be a duodenum bleed.

If the NG tube showed green bile, then they go for Colonoscopy.

-UW says putting an NG tube isnt that useful, as you cant do much therapy with it. They opt for immediate Colonoscopy

3. After that, if still a source isnt found, Nuclear tagging of RBC's can be done. Both Kaplan/UW assert to this fact.

Anyone care to shed light on what should be the NBS? An NG tube or go for Colonoscopy?

In practice, we will do both, but these freaking exams want only one best thing! UGHGHHHHH!
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  #2  
Old 06-03-2014
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I think UW agrees with K that NG tube is the next step after the stabiliztion steps. If the NG returns with blood-->upper endoscopy, If the NG no blood but with bile, -->colonoscopy.

The only thing UW didn't say is what to do if NG no blood no bile.

see 2340 for reference.

Quote:
Originally Posted by Smashingdude View Post
Hey everyone,

So just wanted to confirm this troubling accept of the next immediate best steps. Kaplan says something else, while UW says a different strategy. Here is a flow chart of what I think the workup should be.

1. Irrespective, the first steps are always stabilization : Large bore needles, Type and crossmatch, Correct coagulation/FFP/Plts as needed
2. Here is where my problem comes up:

-kaplan says to put an NG tube and see if the blood is coming from above. If the NG tube shows green bile, you can be sure its not from up. Or if it returned clear fluid, you still have to do an Upper Endo since that means the tube never reached beyond pylorus and there may still be a duodenum bleed.

If the NG tube showed green bile, then they go for Colonoscopy.

-UW says putting an NG tube isnt that useful, as you cant do much therapy with it. They opt for immediate Colonoscopy

3. After that, if still a source isnt found, Nuclear tagging of RBC's can be done. Both Kaplan/UW assert to this fact.

Anyone care to shed light on what should be the NBS? An NG tube or go for Colonoscopy?

In practice, we will do both, but these freaking exams want only one best thing! UGHGHHHHH!
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abeer (06-03-2014)
  #3  
Old 06-03-2014
Smashingdude's Avatar
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Not quite. In Step 3 UW, they opt for colonoscopy. Thats where my whole confusion arose!

PS: I posted a step 3 question here cause step3 forums are pretty dead
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