Podcasts about ugib

Welcome back to the tasty morsels of critical care podcast. Today we’re going to look at the red stuff – blood, and when to give it. This will cover some of Oh’s Manual chapter 97 covering blood transfusion. But we’ll have a focus on transfusion targets. There’s a nice narrative of evidence here over the past 20 years that has given us a relatively robust evidence base for practice in this area, something quite novel in critical care. Blood is expensive and unlike fossil fuels currently remains a renewable resource in the healthy population, it is obviously quite limited and nations frequently experience shortage of various blood groups and products that can have significant impacts on health care delivery. The red cells we give undergo a number of changes in the donation process with “storage lesions” becoming more prevalent over the duration of storage. A list of potential problems with stored red cells might run as follows: red cells change in shape biconvave to spherocytes (echinocytes) losing flexibility change in red cell membrane leading to sticking to the endothelium (esp in activated states like sepsis) 2,3 DPG depletion (which means Hb holds onto Oxy) reduced NO progressive increase in K+ acidosis The ABO reactions of transfusion should be dealt with by good governance of your transfusion service but fevers and other reactions are still an issue. The wonderfully named TRALI and TACO are also well described and space precludes a detailed discussion of these in this post. Now that we know giving red cells is not an entirely benign intervention we are left with the question that all competitive limbo dancers are faced with on a daily basis – how low can you go. What would be an appropriate Hb target for a critically ill patient. So let me tell you a little story… back in the late 90s when i was binging on OK Computer some Canadians led by Paul Hebert produced a large observational cohort of ICU patients called the TRICC trial suggesting that those with lower Hb did poorly and those who got more transfusions did better. But they were good empiricists and acknowledged that this could all be confounded by unmeasured factors. The only way to deal with that is randomisation and so 2 years later, Paul Hebert was at it again producing the TRICC 2 trial. This time an 800 pt multicentre randomised trial looking at Hb of 7 v 10. The headline result here was that the restrictive group did at least as well and probably better than the liberal transfusion group. This was a major trial and I’m pretty sure triggered a major change in practice. The caveats to this were as expected – those with ischaemic heart disease should probably have a higher target. Things went quiet for a few years but in 2010 we saw the TRACS trial from Brazil looking at one of the sacred cows of transfusion targets – cardiac surgery. Can we lower the Hb target in those with dodgy coronaries? They looked at Hb 9 vs 10.5 and found no difference. Villaneueva in 2013 took on upper GI bleeds. They smartly excluded the unstable active bleeders but in 500 patients randomised to 7 v 9, the lower target won out. The trials started to come thick and fast now with TRISS trial in 2014 taking on sepsis. The problem in sepsis is oxygen delivery so surely more Hb is good. But yet again, in 1000 pts with sepsis there was no benefit in targeting 9 vs 7 2015 brought the TRIGGER trial (hopefully you’re starting to see the unofficial naming convention here…) looking again at UGIB and again finding no benefit to the higher target 2017 brought the TRICS 3 trial, looking at 5000 patients undergoing cardiac surgery. Again randomised, this time 7.5 v 9.5, again no advantage to the higher target in 2021 they took on ACS patients in the REALITY trial, the most obviously ischaemic group and randomised 8 v 11 and no benefit to the higher target Most recently in 2025 the TOP RCT looked at vasculopaths having vascular surgery and in 3000 pts there was no benefit to the higher target. Phew… that’s a lot of trials but I think you’re starting to get the point that in general the answer to the question “what is your Hb target” is going to be 7-8 There are of course caveats to throw in at this stage. Firstly, it’s important to note that none of these trials looked at the exsanguinating patient where you should be targeting physiology like HR and BP and perfusion rather than Hb. Restrictive Hb targets are in general questions for the daily ward round rather than the massive transfusion protocol. Finally, in the past couple of years we’ve seen 2 RCTs looking at critically ill patients with sick brains. One looking at TBI and the other looking at SAH. Both suggest that if you have a sick brain you probably should be targeting a higher Hb of 9 or so. When you look at their outcomes the differences do not reach statistical difference in either trial but the trends are clearly to my eye towards more blood leading to better outcomes. Reading: LITFL has a lovely written summary of all the major trials I have included the two neuro trials here as they’re not noted in the LITFL summary Turgeon, A. F. et al. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N. Engl. J. Med. (2024) doi:10.1056/nejmoa2404360. English, S. W. et al. Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage. N. Engl. J. Med. 392, 1079–1088 (2025).

In this episode of the Emoroid Digest Podcast, we go to Canada for our guest Dr. Alan Barkun and discuss the guidelines from the American College of Gastroenterology on Upper Gastrointestinal and Ulcer bleeding. Dr. Barkun is professor of Medicine in the Division of Gastroenterology at McGill University and the McGill University Health Centre, Montréal, Canada. He is a recipient of the DG Kinnear Chair in Gastroenterology at McGill University. Dr. Barkun has published over 800 peer-reviewed articles and abstracts and has given over 600 international presentations on emerging digestive endoscopic technologies, with an emphasis on methodological, clinical and cost-effectiveness trials of treatments for upper gastrointestinal bleeding (UGIB), bilio-pancreatic diseases, and colorectal cancer screening.    Host: Dr. Chuma Obineme (GI Fellow) –  https://twitter.com/TypicallySilent  Co-Host: Dr. Jason Brown - https://med.emory.edu/directory/profile/?u=JMBROW2  Guest: https://www.mcgill.ca/gastroenterology/alan-barkun Link to Guideline: https://pubmed.ncbi.nlm.nih.gov/33929377/ Link to Emoroid Digest Visual Summary: https://twitter.com/EmoryGastroHep/status/1438626435527155713?s=20 Link to Emoroid Digest Website: https://med.emory.edu/departments/medicine/divisions/digestive-diseases/education/emoroid-digest.html  

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Have you heard of Goody's or BC powder? Can you guess how much NSAIDs are in each packet!? Its a wonder how few people get GI bleeds when you read the label on these OTC meds. Let's talk UGIB, diagnosis, management, and pearls and pitfalls.

Dr. Navin Kumar, an attending Gastroenterologist at Brigham and Women's Hospital, medical educator at Harvard Medical School, and co-founder of the Run the List podcast, and Dr. Walker Redd, a Gastroenterology fellow at the University of North Carolina and co-founder of RTL, discuss variceal upper GI bleeding to build upon the principles discussed in the non-variceal UGIB episode. In this episode, Navin and Walker use a case discussion to emphasize the importance of recognizing which patients are at risk for variceal bleeding, what distinguishes variceal GI bleeding from other sources of GIB, initial steps in management, and additional considerations to keep in mind when caring for these patients.

In this episode we discuss a recent paper published jointly in The American Journal of Gastroenterology and the Journal of the Canadian Association of Gastroenterology entitled American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period and co-authored by a Canada – United States team of experts.The interview with co-authors Dr Alan Barkun and Dr Jim Douketis covers the rationale for the new guidelines as well as the implications for clinicians. Dr Barkun is Professor of Medicine in the Division of Gastroenterology at McGill University and the McGill University Health Centre, Montréal, Canada. He is current holder of the DG Kinnear Chair in Gastroenterology at McGill University. Recipient of many national and international awards, Dr. Barkun has published over 400 peer-reviewed articles and abstracts and has given over 600 international presentations on emerging digestive endoscopic technologies, with an emphasis on methodological, clinical and cost-effectiveness trials of treatments for upper gastrointestinal bleeding (UGIB), bilio-pancreatic diseases and colorectal cancer screening. He is also the current President of the colorectal Cancer screening implementation committee for the province of Quebec. ANDDr. Douketis is Staff Physician in General Internal Medicine and Clinical Thromboembolism at St. Joseph's Healthcare Hamilton. He is a Professor of Medicine and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University. Dr Douketis is past-president of Thrombosis Canada.Dr. Douketis' research interests include perioperative antithrombotic therapy, prognosis of patients with venous thromboembolism, hormonal therapy and thrombosis, prevention of venous thrombosis in medical patients, and clinical practice guideline development.Dr. Douketis is a Fellow of the Canadian Academy of Health Science,  Associate Editor of McMaster Textbook of Internal Medicine, Editor-in-Chief of Canadian Journal of General Internal Medicine, Deputy Editor of Annals of Internal Medicine ACP Journal Club, and Associate Editor of Thrombosis and Haemostasis. He has over 350 peer-reviewed publications.Related Thrombosis Canada Resources:DOAC Bleeding Management Clinical Guide:  [LINK]DOAC Perioperative Management Clinical Guide: [LINK]Perioperative Anticoagulant Algorithm: [LINK]Follow us on Twitter: @thrombosiscanReference:Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Journal of the Canadian Association of Gastroenterology. 2022 Apr;5(2):100-1Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this week's episode we are happy to welcome Dr Farhad Peerally, gastroenterology registrars in East Midlands to discuss a comprehensive approach to UGIB management. Essential listening.

Core Questions   Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location  Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4   Wisecracks   Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

Core Questions   Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location  Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4   Wisecracks   Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

It’s the JournalFeed Podcast for the week of Aug. 31 - Sept. 4, 2020. We cover a review of acute ischemic stroke, ACP/AAFP musculoskeletal pain guidelines, antibiotics for cirrhosis with upper GI bleed, early norepinephrine for septic shock, and the best way to tape an ETT so it won’t come out.

Background: Upper endoscopy allows for the identification of the source of bleeding as well as hemostatic treatment for actively bleeding lesions In patients with upper... The post REBEL Cast Ep82: Timing of Endoscopy for UGIB appeared first on REBEL EM - Emergency Medicine Blog.

Pearls for Patients with Acute UGIB

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the December 04, 2018 issue

From ECHONooga, Dan Rauh and Bill Hinckley bring us their talks on bleeding. Dan Rauh will discuss coagulopathy/anticoagulants.  Do you understand the difference between a NOAC, VKA, INR, 4 factor PCC AND FFP? Do the concepts of intrinsic and extrinsic pathway trigger a migraine? Not anymore!!! Who, when and how to reverse will be covered as well as the most important question....”How do I do that?!”   Dr. Bill Hinckley will bring his talk, Master of the Massive UGIB. We’re experts in managing hemorrhagic shock from trauma, and we know that in bleeding trauma patients, the care that we bring to the patient is at least as important as the rapid transport we provide to the Level 1 Trauma Center. I get stoked about massive UGIBs in the same way that we all get fired up to take care of that MVC patient with severe TBI and florid shock. Why? Because I know there’s very little the accepting GI doc and intensivist have that my partner and I don’t have in terms of definitive care for that massive UGIB patient. I know, and you will too, that in a short period of time we can have a huge impact on that patient’s morbidity and mortality. And because I’m anosmic, so the aroma of melena doesn’t bother me in the least. Even if you’re not anosmic, I think I can get you pumped up about taking care of massive UGIBs too. You will hear a Moment of Silence during Dr. Hinckley's talk. Here's why: All classes were paused for a moment of silence at 1120 in remembrance of Duke Lifeflight Crew Crystal Sollinger, Kristopher Harrison, Jeff Burke, and Mary Bartlett.

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they're not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don't forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage EMCrit:

This episode covers Chapter 30 of Rosen's Emergency Medicine. Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB 4) List 6 low-risk criteria D/C of GIB 5) List components of the Rockall and Glasgow-Blatchford score Wisecracks: 1) Describe the insertion of a Blakemore tube 2) List 6 causes of false positive stool guaic

This episode covers Chapter 30 of Rosen's Emergency Medicine. Episode overview: 1) List 5 causes of UGIB in adults and pediatrics 2) List 5 causes of LGIB in adults and pediatrics 3) Describe your management approach for severe UGIB 4) List 6 low-risk criteria D/C of GIB 5) List components of the Rockall and Glasgow-Blatchford score Wisecracks: 1) Describe the insertion of a Blakemore tube 2) List 6 causes of false positive stool guaic