Volume 3, Number 15; October 11,, 2004
|
Volume 3, Number 15; October 11,, 2004 |
|
|
|
|
|
|
|
|
Bleeding Alcoholic Gentleman...
(Dr. Checkley)
Recommended reading:
|
Resident Report 1011/04—William Checkley
Case: A 52 year-old male with a history of alcohol abuse and chronic hepatitis C is brought to the Emergency Department after an episode of bloody emesis. Paramedics estimated 600 ml of blood loss. After placement of an NG tube, it is established that the patient is actively bleeding from the upper gastrointestinal tract. Initial vitals are notable for a blood pressure of 96/48, pulse of 72, and an oral temperature of 35.7C. Patient is oriented to person and place upon arrival to the ED. Physical exam is notable for pallor, spider angiomas on the face and chest, hepatomegaly, abdominal ascites, and asterixis. Initial laboratories indicate: Hemoglobin of 9.1 from a baseline of 13.5, platelet count of 127, INR of 1.5, BUN of 26, serum creatinine of 0.6, serum bicarbonate of 22, and albumin 2.1.
Patient undergoes EGD and is found to have grade 3 varices. He promptly undergoes banding of his varices.
|
|
Clinical Question(s):
1) what are the indications for elective intubation in the setting of a variceal bleed?
2) what are the clinical predictors of mortality after a variceal bleed?
|
|
Readings:
|
|
|
|
|
Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2004 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Monica Adams MD / Josh Larned MD
Contact:
Karl Woodworth
|
