Posts
Today's topic: gastrointestinal hemorrhage in an anticoagulated patient.
First: guidelines for management of peptic ulcer bleeds from the American College of Gastroenterology: Their 30 key recommendations available here, also has link to full text of their guideline for additional reading.
Contrast those recommendations with the ones provided for management of variceal hemorrhage. Key differences in variceal hemorrhage:
- Octreotide and prophylactic antibiotics indicated for variceal bleed
- All variceal bleeds require ICU admission, whereas only the high risk subset of ulcer bleeds even require hospitalization.
As for reversal of anticoagulants, this handy pocket card from the American Society of Hematology covers dosing as well as reversal of multiple anticoagulant and antiplatelet medications. Their guidelines are available as an app as well.
Cardiogenic Shock
Also from noon conference - make sure you know your mechanical complications of acute myocardial infarction well. This topic is all over the boards and in training examinations.
Also, remember that right ventricular infarction is something of a unique clinical syndrome. Nitrates can do great harm, and large amounts of volume resuscitation are often required to overcome RV dysfunction, Diagnosis in the setting of IWMI requires a R sided ECG, with lead V4r being the highest yield lead for diagnosis.
