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Lower GI Bleeding Guidelines Update

Using the shock index, CTA, DOAC reversal... The British Society of Gastroenterology recently released their guidelines on LGIB bleeding evaluation and management. This post will provide you with the key takeaways.

em@3am

EM@3AM: Jaundice in Adults

A 53-year-old male presents with nausea/vomiting and complains of turning “yellow”. He denies abdominal pain, fever, alcohol use, or acetaminophen intake. His vital signs are normal, and exam reveals icteric sclerae, jaundice of his face and chest, and hepatomegaly. He has no tenderness to abdominal palpation. What’s going on, and what’s your next step in evaluation and treatment?

em@3am

EM@3AM: Post-Tonsillectomy Complications

An 8-year-old male presents 7 days post-tonsillectomy. His mother states he started spitting up blood this morning. The patient appears well, but suddenly starts throwing up coffee ground emesis. When the patient stops throwing up, you look at the back of the throat and see what appears to be a clot. What’s the next step in your evaluation and treatment?

em@3am

EM@3AM: Pelvic Ring Fracture

A 23-year-old male is brought in by EMS from the scene of a severe accident. He is hypotensive and tachycardic, with a mangled right lower extremity and right upper extremity. EMS applied a tourniquet to both the right upper and lower extremity. Your initial primary survey reveals properly placed tourniquets. With inward pressure on the iliac wings, you detect pelvic instability. What’s the diagnosis, and what’s your next step in your evaluation and treatment?

em@3am

EM@3AM: High-Pressure Injection Injury

A 43-year-old male right hand dominant man presents with pain and swelling of his left index finger. He is a professional painter and was using an industrial pain sprayer when he injected his left index finger. It now is exquisitely painful, with a large degree of swelling. What’s the diagnosis, and what’s your next step in your evaluation and treatment?