Tuesday, April 18, 2017

Resuscitate Before You Endoscopate?

R.E.B.E.L.EM Episode 36 – April 17, 2017
"Clinical Take Home Point:
In HD unstable patients the triage point to deciding on how early to perform endoscopy is response to resuscitation. If they stabilize, they can go to the ICU with frequent assessments with a courtesy call to our GI colleagues. The patients who transiently stabilize or don’t stabilize at all despite resuscitation (i.e. Already doing everything that we can from a medical standpoint: blood products, pressors, intubation, PPI, Octreotide, etc.) need hemostasis and the only way this is going to happen is with endoscopy. For these patients, we need to get GI in at whatever time of the day it is. So you still resuscitate before endoscopy (or as I like to say resuscitate before you endoscopate), but the response to that resuscitation is what determines who should get scoped sooner (i.e <2hrs, <3hrs, <6hr etc…)"