Pediatric emergency medicine trisk 2042 2042
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Goals of Treatment
GI bleeding is a common and occasionally life-threatening condition in infants
and children. An orderly approach to this problem is essential (see Chapter 33
Gastrointestinal Bleeding ). Significant GI bleeding places a patient at risk of
circulatory collapse. The goal for the ED provider is to address lifethreatening GI bleeding by stopping the ongoing losses and replacing
intravascular volume. Addressing ongoing bleeding will require a team of
professionals that may include the emergency physician, hospitalist, surgeon,
gastroenterologist, hematologist, and interventional radiologist. Addressing
potential circulatory compromise achieves two principal objectives: Oxygencarrying capacity is improved through administration of blood products and
the perfusion pressure to vital organs is preserved via blood product and
intravenous (IV) fluid administration.
The vast majority of patients with either upper or lower GI bleeding will not
have experienced significant blood loss. These patients can be managed
successfully with judicious laboratory investigation, supportive care, and
follow-up with a primary care provider or an appropriate subspecialist.
UPPER GASTROINTESTINAL BLEEDING
Esophageal Varices
Goals of Treatment
The initial goals of therapy of suspected variceal hemorrhage are identical to
those of massive upper GI bleeding from any source. Volume resuscitation to
maintain adequate perfusion and oxygen-carrying capacity is necessary, but
overexpansion of the intravascular volume should be avoided because it may
contribute to rebleeding. Patients with actively bleeding esophageal varices
(EV) may also have liver dysfunction and, as a result, early therapy should
also correct existing coagulopathies.
CLINICAL PEARLS AND PITFALLS
