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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Emergency medicine updates: Lower gastrointestinal bleeding
1SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Insights
Emergency clinicians should review updated evidence for diagnosing and managing lower gastrointestinal bleeding (LGIB). Key updates include imaging choices like CT angiography for severe bleeding and colonoscopy for stable patients, alongside transfusion guidelines.
Area of Science:
- Emergency Medicine
- Gastroenterology
- Clinical Evidence Updates
Background:
- Lower gastrointestinal bleeding (LGIB) is a frequent emergency department presentation.
- Effective diagnosis and management are crucial for emergency clinicians.
Purpose of the Study:
- To evaluate key evidence-based updates regarding LGIB.
- To provide current information for emergency clinicians managing LGIB.
Main Methods:
- Review of current literature and evidence-based updates on LGIB.
- Focus on diagnostic and management strategies relevant to emergency settings.
Main Results:
- Common LGIB etiologies include diverticulosis and anorectal disease; most cases resolve spontaneously.
- CT angiography is preferred for severe bleeding; colonoscopy for stable patients.
- Transfusion threshold of 7 g/dL hemoglobin recommended, with emergent transfusion for hemodynamic instability.
Conclusions:
- Staying informed on literature updates enhances patient care for LGIB.
- Clinical judgment remains paramount in patient disposition, despite risk scores.
Introduction:
Lower gastrointestinal bleeding (LGIB) is a condition commonly seen in the emergency department. Therefore, it is important for emergency medicine clinicians to be aware of the current evidence regarding the diagnosis and management of this disease.
Objective:
This paper evaluates key evidence-based updates concerning LGIB for the emergency clinician.
Discussion:
LGIB is most commonly due to diverticulosis or anorectal disease, though there are a variety of etiologies. The majority of cases resolve spontaneously, but patients can have severe bleeding resulting in hemodynamic instability. Initial evaluation should focus on patient hemodynamics, the severity of bleeding, and differentiating upper gastrointestinal bleeding from LGIB. Factors associated with LGIB include prior history of LGIB, age over 50 years, and presence of blood clots per rectum. Computed tomography angiography is the imaging modality of choice in those with severe bleeding to diagnose the source of bleeding and guide management when embolization is indicated. Among stable patients without severe bleeding, colonoscopy is the recommended modality for diagnosis and management. A transfusion threshold of 7 g/dL hemoglobin is recommended based on recent data and guidelines (8 g/dL in those with myocardial ischemia), though patients with severe bleeding and hemodynamic instability should undergo emergent transfusion. Anticoagulation reversal may be necessary. If bleeding does not resolve, embolization or endoscopic therapies are necessary. There are several risk scores that can predict the risk of adverse outcomes; however, these scores should not replace clinical judgment in determining patient disposition.
Conclusions:
An understanding of literature updates can improve the care of patients with LGIB.
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