Review Question - QID 102631

This patient is suffering from a GI bleed, as evidenced by her hematochezia (bright red blood per rectum). A patient presenting with a GI bleed should undergo a type and screen to allow for prompt blood transfusion if it becomes necessary.

The initial management of a patient with a GI bleed is to first assess the ABC's including managing their airway and ensuring the patient has good IV access and is able to receive fluids/blood products if needed. If the patient is actively and rapidly bleeding or has a hemoglobin < 7.0 g/dL, they should be transfused. Otherwise, they should receive a type and screen to prepare for a transfusion if it is required. Subsequent management will involve a colonoscopy to determine the source of the bleeding.

Incorrect Answers:
Answer 1: Colonoscopy is indicated for evaluation of a suspected lower GI bleed after this patient has been appropriately stabilized and a type and screen has been obtained.

Answer 2: CT abdomen can be used to visualize bleeding in the peritoneal cavity or retroperitoneum. An abdominal CT with contrast can be used to localize a source of bleeding in some circumstances; however, colonoscopy is the preferred diagnostic test for a lower GI bleed.

Answer 3: Fresh frozen plasma might be indicated if this patient were on warfarin (or thought to be anticoagulated for some other reason); however, it does not take priority over preparing to transfuse the patient if they start bleeding again.

Answer 4: Packed red blood cells would be indicated if this patient had a hemoglobin < 7.0 g/dL or if they were actively and rapidly bleeding (since the hemoglobin would likely drop precipitously in this situation). This patient's resolved bleeding and hemoglobin > 7.0 g/dL makes this a less dire step.

Bullet Summary:
Patients with a GI bleed should initially be stabilized with IV access, fluids, blood products (if indicated), and a type and screen.