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- Oct 20, 2003
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So, on my last week in NYC, I got some really horribly sick patients. This one was signed out to me.
This one netted the oddest consult request from the ICU.
71 yo female came in (walking/talking) with a ? hx of melena. (? because of language barrier). Different resident went to see the patient and sure enough, melena, brbpr and the patient proceeded to start having a little bit of brb from her mouth. NGT pulls out 2 liters of brp. To make a long story short, she is intubated and gi scopes her seeing varices but can't isolate the source. She's on all the standard stuff, including pressors and is semi stabilized and signed out. (4 units prbc at this time).
about an hour later, BRB starts pouring out the mouth. We put in a blakemore tube (getting out another 5 more liters of blood in less than 5 minutes). The bleeding seems to stop. she is now about 10 units in, 10 liters in, ffp, platelets etc. Labile bp, tachy.
ICU wants a surgical consult and an IR consult. (No way is she going to the IR suite).
Now, I can't figure out what they wanted the surgeons to do. partial gastrectomy? She had varices.
Am I missing something?
This one netted the oddest consult request from the ICU.
71 yo female came in (walking/talking) with a ? hx of melena. (? because of language barrier). Different resident went to see the patient and sure enough, melena, brbpr and the patient proceeded to start having a little bit of brb from her mouth. NGT pulls out 2 liters of brp. To make a long story short, she is intubated and gi scopes her seeing varices but can't isolate the source. She's on all the standard stuff, including pressors and is semi stabilized and signed out. (4 units prbc at this time).
about an hour later, BRB starts pouring out the mouth. We put in a blakemore tube (getting out another 5 more liters of blood in less than 5 minutes). The bleeding seems to stop. she is now about 10 units in, 10 liters in, ffp, platelets etc. Labile bp, tachy.
ICU wants a surgical consult and an IR consult. (No way is she going to the IR suite).
Now, I can't figure out what they wanted the surgeons to do. partial gastrectomy? She had varices.
Am I missing something?