Pediatric emergency medicine trisk 2048 2048
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Renal
Digital clubbing
Cyanosis
Portopulmonary
hypertension
Edema
Abdominal
distention/ascites
Hepatorenal syndrome
Hypervolemia
Transfusion of blood products may be necessary to maintain adequate endorgan perfusion with severe GI bleeding. The volume of blood products that
should be administered as well as the timing of those transfusions is
controversial. Current recommendations generally target a hemoglobin
transfusion goal of 7 to 8 g/dL. Excessive blood administration, especially in
the setting of non–life-threatening bleeding, should be avoided, as it is known
to contribute to rebleeding. Coagulation abnormalities should be managed
aggressively only if there is active bleeding, as transfusion of blood products
may lead to volume overload. In patients who are not actively bleeding, the
ED physician should not attempt to correct a coagulopathy as a patient’s PT
and INR can be very difficult to correct and are not reliable indicators of
bleeding risk in those with underlying liver disease. It is also important to note
that bleeding varices may be the initial sign of sepsis in patients who have
cirrhosis. Prophylactic broad-spectrum antibiotics, after appropriate cultures
are obtained, are recommended in the setting of a significant esophageal
bleed.
