Lower GI Bleeding - Dr. Johnson

• Take a good history! (Color, Amount, Time, Coagulant use, History of prior bleed) 
  
• Ask about prior colonoscopy. 
  

Higher Risk Patients

• Higher morbidly from lower GI bleeding comes from those who are unstable in the ED, have a nontender abdomen, syncopize, take Aspirin, or have other medical co-morbidities. 
  

Unstable Patients

• In the unstable patient who is still bleeding, give blood and consider TXA. 
• In the patient on aspirin, give platelets and/or desmopressin. 
• For a Coumadin patient, give Vitamin K and FFP or consider prothrombin complex concentrate. 
• If you're giving blood, think about calling surgery in addition to GI. 
• If the bleed is ongoing BRB, talk to inpatient team about tagged RBC scan or angiography. 
• "Rapid" colonoscopy is 3-4 hrs at the fastest. 
  
• Get an upper endoscopy before a CT in patient with concerning symptoms for aortoenteric fistula. 
  

Mimics for Lower GI bleeding:

• Melena - Pepto-bismol and Iron supplements
• Hematochezia - beets, red grapes, vaginal bleeding, hematuria 
• + FOB - red meat, Vitamin C, turnips, horseradish 

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