Question

A 68 year old woman has bright red blood per rectum. Presumptive dx is bleeding from colonic diverticulum or vascular ectasia (AV malformation). After resuscitation and 2 units of blood, she stabilizes. Initial evaluation reveals no evidence of upper GI bleed, no hemorrhoids, no coagulopathy. Her hct is 35% after transfusion that night. The next morning, she bleeds profusely again with bright red blood per rectum. HR up to 130, BP 100/60. repeat Hct is 24. you resuscitate her and administer 2 units of packed RBCs. what is the overall management plan at this point?

Answer 1

A 68-year-old woman with recurrent bright red rectal bleeding requires further diagnostic and therapeutic measures, including endoscopy, angiography, and possibly surgical intervention, alongside continued hemodynamic monitoring and supportive care.

Step-by-step explanation:

The management plan after resuscitation and administration of two units of packed red blood cells (RBCs) for a 68-year-old woman with bright red blood per rectum should involve further diagnostic and therapeutic measures. The next steps would typically include urgent endoscopy to identify the source of bleeding, possible angiography if endoscopy is not diagnostic or if the bleeding persists despite endoscopic intervention, and surgical consultation may be necessary if these methods fail to control the hemorrhage. Considering the severity and recurrence of the bleeding indicated by a decrease in hematocrit to 24% and vital sign changes, these interventions should be undertaken promptly. Additionally, ongoing hemodynamic monitoring and support with further blood transfusions or other blood products may be required based on the patient's condition.