Page 182 - Critical Care Notes

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GI
■ Tachycardia, ↓ pulse pressure, MAP <60 mm Hg, capillary refill sluggish
■ Cardiac dysrhythmias
■ Tachypnea, shortness of breath, chest pain
■ Pallor, apprehension, confusion, lethargy, weakness
■ ↓ urine output, ↑ urine concentration
■ ↑ bowel sounds, diarrhea
■ Cool, clammy skin and diaphoresis
■ Stupor and coma if large blood loss
■ Multiple organ dysfunction if severe blood loss (>30% blood volume) and
hypovolemic shock
Diagnostic Tests
■ CBC, platelets, and coagulation studies
■ Serum chemistries, liver function tests, and BUN/creatinine ratio
(if >36 → GI bleeding if no renal insufficiency)
■ ECG to detect arrhythmias
■ ABGs or pulse oximetry
■ UGI series
■ Abdominal x-ray or CT of abdomen
■ Barium enema
■ GI bleeding scan
■ Endoscopy including test for Helicobacter pylori
■ Colonoscopy or sigmoidoscopy
■ Mesenteric angiography
Management
■ Monitor vital signs and hemodynamics (central venous pressure (CVP), pul-
monary artery pressure [PAP]). Arterial line recommended. Note ↓ BP, ↑ HR,
↓ CVP and cardiac output and other signs of shock. Treat shock symptoms.
■ Use ECG monitoring and assess for cardiac dysrhythmias.
■ Assess respiratory status and ABGs or pulse oximetry. Administer O 2 via
cannula, mask, or mechanical ventilation. Assess for signs of hypoxia.
■ Insert large-bore NG tube and set at low intermittent suction. Lavage as
necessary with tap water or saline. Avoid iced lavage. Assess color and
amount of drainage. Note bright red to coffee-ground drainage. Keep
patient NPO if actively bleeding. Start clear liquids when bleeding stops.
Keep head of bed elevated.
■ Place patient in left lateral decubitus position to ↓ risk of aspiration from
acute bleeding.
■ Assess bowel sounds; assess abdomen for distention and palpate for pain.
■ Fluid resuscitation with two large-bore IV catheters or central access. Administer
IV fluids (LR or NS), colloids, crystalloids, blood, and blood products.
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