IBCC Episode 3 - Approach to the GI Bleed | The Internet Book of Critical Care Podcast

In this IVCC podcast episode, Josh and Adam Thomas discuss the diagnosis and management of GI bleeding. They cover key aspects such as differentiating GI bleeds from posterior epistaxis and colitis, and they emphasize the importance of assessing hemoglobin, hemodynamics, coagulation, and signs of bleeding. They highlight the significance of considering cirrhosis and overall patient fitness in risk stratification. The discussion includes practical advice on lab tests like fibrinogen, access considerations, blood product transfusions, and managing coagulopathy with medications like PPIs, octreotide, antibiotics, and TXA. The hosts delve into upper and lower GI bleeds, including variceal hemorrhages and the use of CT angiography, and they also share algorithms for diagnosis and intervention, stressing the importance of source control and avoiding over-resuscitation.

Outlines

Part 1: Introduction and Initial Assessment

Part 2: Management and Medications

Part 3: Lower GI Bleeds and Interventions

Part 4: Surgical Considerations and Key Takeaways

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IBCC Episode 3 - Approach to the GI Bleed

The Internet Book of Critical Care Podcast

Part 1: Introduction and Initial Assessment

Introduction to GI Bleeding and Initial Considerations

Hemodynamics, Signs of Bleeding, and High-Risk Patient Populations

Universal Supportive Care: Labs and Coagulation

Part 2: Management and Medications

Fibrinogen Levels, Access, and Blood Products

Transfusion Targets and Coagulopathy Management

Medications: PPIs, Octreotide, and Antibiotics

TXA, Upper GI Bleeds, and Intervention Sequence

Aortic Fistulas, Variceal Hemorrhage, and Over-Transfusion

Part 3: Lower GI Bleeds and Interventions

INR Correction in Cirrhotics, Vasopressors, and Introduction to Lower GI Bleeds

Differentiating Upper and Lower GI Bleeds and the Role of NG Lavage

CT Angiography for Lower GI Bleeds

Advantages of CT Angiography over Tagged RBC Scans and the Role of Interventional Radiology

Part 4: Surgical Considerations and Key Takeaways

Surgical Intervention and Common Pitfalls

Key Takeaways and Checklist

IBCC Episode 3 - Approach to the GI Bleed

The Internet Book of Critical Care Podcast

Part 1: Introduction and Initial Assessment

00:02Introduction to GI Bleeding and Initial Considerations

Introduction to GI Bleeding and Initial Considerations

02:37Hemodynamics, Signs of Bleeding, and High-Risk Patient Populations

Hemodynamics, Signs of Bleeding, and High-Risk Patient Populations

05:03Universal Supportive Care: Labs and Coagulation

Universal Supportive Care: Labs and Coagulation

Part 2: Management and Medications

06:26Fibrinogen Levels, Access, and Blood Products

Fibrinogen Levels, Access, and Blood Products

08:23Transfusion Targets and Coagulopathy Management

Transfusion Targets and Coagulopathy Management

10:14Medications: PPIs, Octreotide, and Antibiotics

Medications: PPIs, Octreotide, and Antibiotics

12:21TXA, Upper GI Bleeds, and Intervention Sequence

TXA, Upper GI Bleeds, and Intervention Sequence

13:37Aortic Fistulas, Variceal Hemorrhage, and Over-Transfusion

Aortic Fistulas, Variceal Hemorrhage, and Over-Transfusion

Part 3: Lower GI Bleeds and Interventions

15:32INR Correction in Cirrhotics, Vasopressors, and Introduction to Lower GI Bleeds

INR Correction in Cirrhotics, Vasopressors, and Introduction to Lower GI Bleeds

16:49Differentiating Upper and Lower GI Bleeds and the Role of NG Lavage

Differentiating Upper and Lower GI Bleeds and the Role of NG Lavage

18:31CT Angiography for Lower GI Bleeds

CT Angiography for Lower GI Bleeds

20:08Advantages of CT Angiography over Tagged RBC Scans and the Role of Interventional Radiology

Advantages of CT Angiography over Tagged RBC Scans and the Role of Interventional Radiology

Part 4: Surgical Considerations and Key Takeaways

22:22Surgical Intervention and Common Pitfalls

Surgical Intervention and Common Pitfalls

24:25Key Takeaways and Checklist

Key Takeaways and Checklist