Baby Bones
Describe a type 1 Salter Harris Fracture
Fracture plane passes all the way through the growth plate
T/F a guaiac positive stool can tell you where the GI bleed is located
False
Indicates slow pace and low volume bleeding
What are the 6 things we look at in the initial assessment of GI bleeds if we think we will need to resuscitate the patient?
1. blood loss in mL
2. blood volume loss in %
3. HR
4. Systolic BP
5. Urine output in ml/hr
6. Mental status change (alert, anxious, aggressive/drowsy, confused/unconscious)
This scoring system predicts the need for endoscopic therapy for GI bleeds and looks at blood urea, Hgb, sBP, pulse, liver disease, heart failure
Blatchford Score
Number 1 cause of lower GI bleed
diverticulosis
With an elbow fracture, which three nerve tests should you preform?
Radial nerve test, median nerve test, ulnar nerve test
______ is the v dark, tarry, pungent stool that is usually indicative of upper GI bleed
Melena
What kind of IV should you always use with patients who may need resuscitation?
Large bore peripheral (good idea to have 2)
You should give IV ____ at 80 mg bolus, 8 mh/hr drip before the scope to suppress acid, facilitate clot formation and stabilization
PPI
*has not been shown to reduce rebleeds, surgery, or mortality
PUD, gastroesophageal varices, erosive esophagitis, and Mallory Weiss tears are (upper or lower) bleeds
Upper GIB
A fracture passing directly through the metaphysic, growth plate, and epiphysis. Which salter Harris classification # would this be?
IV
Help! My stool is bright red and sometimes maroon! What is this called and where is my bleed?
Hematochezia; typically colonic origin
What should you give before pressors if needed for a resuscitation patient?
Crystalloids because you need something to maintain pressure in the vascular system
T/F minor stigmata (flat pigmented spot or clean base) has a high rebleed risk and needs endoscopic therapy
false
Colitis, hemorrhoids, and angioectasias are
lower GIB
Femoral anteversion usually resolves by what age?
10 years old
T/F An UGI bleed must still be considered in patients with severe hematochezia even if NG aspirate is negative
True, can't rule this out yet
I have a patient whose Hgb is 7 and I want to raise it to 9. How many units of PRBCs should I give him?
2 units
1 unit of PRBCs should raise the Hgb by 1 point
Post-endo, the patient is switched to oral PPI. How long should you keep them on this and why?
72 hours; reduces rebleed rate
This rare UGIB is one you cannot afford to miss
Aortoenteric fistula
An aortoenteric fistula is a connection between the aorta and the intestines, stomach, or esophagus. There can be significant blood loss into the intestines resulting in bloody stool and death. It is usually secondary to an abdominal aortic aneurysm repair.
Pavlik harness or spica cast is the treatment for
Developmental dysplasia of the hip
(Most commonly seen in female children)
Congrats! You get a freebie :) Take away points from GIBs:
1. examine stool color yourself
2. don't order guaiac test on inpatients
3. severe hematochezia can be from UGIB
4. all bleeding eventually stops
5. early resus and supportive care are MAJOR KEY to reducing morbidity and mortality
I give my patient 4 units of PRBCs. Initially, the hematocrit will stay the same. However, how much will his HCT increase by after the initial phase? (%)
(It will also drop over time so check serial CBCs)
Bonus: How many units of FFP do I give?
HCT will increase by 12%
1 unit FFP for every 4-5 units of PRBCs given
Therapy for variceal bleeds
Vasoconstrictor therapy (octreotide; decrease blood flow)
Antibiotics - Ceftriaxone or Norfloxacin
Resuscitation - maintain Hgb ~7-8
ICU-level care
Endoscopy - within 12 hours after resuscitation
Alternative/rescue therapy - TIPS procedure
Beta blockers - nonselective (Nadolol for splanchnic vasoconstriction and lowers portal pressure)3 things that predict if it is an upper GIB:
(Age < X)
(Stool color)
(Lab)
-age <50
-melanic stool
-BUN/creatinine ratio (>30 = UGIB)