It may seem hard to believe, but often it’s in a patient’s best interest to NOT scope them right away. I try to explain the GI thought process in these short educational video. NOT intended to be medical advice
THIS. I think the further you specialize the more you forget about every other part of medicine and the more you forget that everyone else has forgotten nearly everything about what you do, myself included. Simple explanations like this are incredibly useful even (if not especially) for other medical professionals. Sometimes I feel like I'm expected to communicate at an expert level with every possible consult, and am left without a really clear understanding of why they made a decision and just have to take their word for it, or risk being chewed out for asking for a layman's explanation of the situation from their perspective. Because even though we all went to medical school, lets be honest, we're all pretty much layman when it comes to other specialties than our own.
You draw us in with funny sketches and then, periodically, provide great educational videos like this! This is a savvy teaching method and I’m very appreciative.
Next, please find a neurosurgeon to explain the old: "Patient too good for intervention, manage medically. Repeat CT head and refer back if they drop their GCS". Neurosurgeon: "Too late for intervention. Medical management."
One Saturday morning a few years ago, I went to the ER when one of my varices ruptured. I was given a blood transfusion and fluids. The bleeding stopped on its own. I was scoped the next morning and the varices were banded. Haven't had any more bleeds or any other issues since I had a liver transplant last year. Thanks, Doc Schmidt! I thought it was weird that they didn't scope right away as well. Makes sense how you explained it.
Nicely explained. Also just to say - IV PPI will take several hours to start kicking in and 72 hours to achieve mucosal healing so pre-endoscopy the focus should be on fluids/blood transfusion and if you want to make the endoscopists day then give some metoclopramide or erythromycin to promote gastric emptying as this can greatly improve views on endoscopy!
This was vital information. THANK YOU :) My 1st year in the ED, I had two patients with GIB. One was a sudden onset and less than 21y/o, who was scoped within 12hrs/ sedated/intubated and more . BTW , it was an awesome experience as an ER nurse to see the entire scoping process. My second one in particular was a hemopytosis /esophageal varices bleeding w/ liver cirrhosis with of-course an acuity status change.I had never seen so much blood from someones mouth as a new ED nurse. This person was placed on IV PPI and Octreotide with frequent H&H and scoping held .
Thank-you for explaining all the different factors in scoping a GI bleed. It's nice to understand the logic or reasoning behind the decisions to scope or not.
This was awesome!! I’ve wondered so many time why scopes get pushed back but I don’t know our GI doctors well enough to know who is safe to ask. I really appreciate it!
I’m glad I found your channel, honestly you have helped me and I go to the gastro doctor tomorrow and I just started having bad stomach problems. So I’m happy to figure out what’s wrong with my stomach,
Thanks for clarifying. I worked in a Liver ITU. So 99% of our patients with active GI Bleed were as unstable as one can be but would still be scoped. I can see other patients would not need an immediate scope.
I have an ileostomy so having been in the GI world a lot your videos are awesome. I'm applying for nursing school in January with hopes to eventually work my way to a gastro unit to help other GI patients like me. Know any gastro docs who want to start a practice here on the Oregon coast?? We need one bad!
Would like to see that study. If it was an RCR, I'd wonder to what extent the decision on scope timing was colored by patient status, which could be a confounder.
Layperson here, but thanks for your videos! I find these interesting and I love learning more about medicine even if I dont know what 90% of the acronyms mean 🤣
I was scoped while bleeding. They had to clip a vessel i think. I had lost about half my blood by the time I arrived at the ER. (Thats a long story) I was scooped like 11hrs after arriving after getting a few bags of blood. My GI said it was only his 3rd time seeing that bad of a bleed and never seen in someone so young (I was 19) That was an interesting expierence to say the least.
Can you do a video on the scope of practice/ different opportunities for GI doctors to work in different environments? Thank you :) Are GI docs encouraged to work in an academic center?
Hi, is it possible if u share the link to the study regarding the outcomes comparing the timing of performing an OGDS on patients? Would be interested in giving it a read... Thank you
Do you think that you would be able to add the publication that you referenced in your video? I ask from the point of view as a 4th year medical student. I feel that it would be important to read the publication that you spoke of.
I understand it’s not as commonly required as one might think but there still must be some situations it is indicated. So what are the situations you would recommend emergent EGD (ie not waiting until the AM)? I work in EM but am curious as to your thoughts.
Could you explain how PPI’s actually stop GI bleeds? I know they control the amount of acid being produced in the stomach but how does that stop a current bleed? Also what indicates a patient getting an octreotide drip vs a PPI drip?
Idk… GI at my hospital won’t come in overnight if we’re calling a code fusion for a hypotensive actively hemorrhaging LGIB :/ “if it’s really that bad, call surgery.” Gotten to the point we just don’t call GI overnight about anything except foreign body ingestion and unstable varices
Or even better general surgery get called because the patient is bleeding before they get any scoping nor IR Embolization.....as if surgical intervention is less traumatic....it is literally cutting out parts of GI tract and stitching for ligation and anastomoses...plus General Anesthesia! Which is more risky than sedation (mostly)
Hi do you mean gastroscopi or colonoscopi ? I suppose if colonoscopi the patient has to take laxatives for many days..or else you dont see anything...Do you do acute colonoskopis in the usa ?
Well usually no There are negligible to no indication for emergent colonoscopy as the bleeding stops so usually not needed and once the patient is hemodynamically stable you can prep and bring him on My teacher used to say do less harm By doing emergency colonoscopy we are doing no good to the patient and also if patient are sedated for the procedure that increases the risk as well But sometimes it can be done for volvulus or obstruction but not for bleeding
I do have question about nuclear medicine and gi bleeds. I was a nuclear medicine tech. We would do gi bleeds study, all the time in the hospital which takes hours and is uncomfortable for patients. If a patient is not actively bleeding, ( would not show up on scans) or even if active bleedingis found. A CT is order either way. Why do nuclear medicine study need to be done, if a CT is the preferred method of imaging. Plus more exposure to patient.
Radiologist here. A CT scan is a static image, a moment frozen in time, it's not dynamic and don't see the blood escaping. With very very rare exceptions (like high volumes of blood lost or being very lucky with the iodine contrast), we CAN'T see any active bleeding in the CT scans, especially in the stomach which is an poorly studied organ with CT scans. On the other hand, Nuclear Medicine makes for dynamic studies, you see the build up of the radiotracer for blood loss in the images. So both exams see different things for the most part, the Nuclear Medicine sees the active blood loss, and the CT scan get an anatomic view to see any other complications that may be associated or even responsible by the disease (like tumors, perforations, etc).
@@irresponse thank u, I do know a nuclear medicine study can show active bleeding. What about when there is not active bleed, can you still see something when no active bleeding is happening? I have just seen nuclear studies come back negative and ct come back positive. I was just wondering why that happens? Haha we called nuclear medicine( unclear medicine) to be honest I never really got the joke.
So the Nuclear Medicine exams in GI bleeding is to answer 2 questions basically: 1- There is an active GI bleeding? (Y / N) 2- If there is an active bleeding, where it is, roughly? High (like in the stomach)? Medium (like in the small intestine)? Or low (like in the colon)? This is importante to guide future *scopes (will be by mouth or by the butt?). The CT scan is to see if there is another associate cause or complication, or even another unrelated disease causing all the problems. GI bleeding is a complex problem with potentially bad outcomes, so we need to be precise about where it is to know what to do.
@@crystallizanich7373 Nuclear will be negative when there is no active bleeding. But if there was a tumor bleeding, or an ulcer that was bleeding but ruptured the stomach wall and "stoped" bleeding but let escape air to the cavity, or a sizeable hematoma from the previous stoped bleeding accumulated in some place, then the CT will show. But it's even more complicated than that, there are cases when both nuclear and CT came negative, and only the *scopes or even that camera capsules can see the causes. But there's more, like the frustrating cases when every possible exam is negative apart from the low hemoglobin, and no one can say for sure why.
Thank you for helping me to understand more. When in school we just have textbooks to go off of, which we all know textbook and real life are to different things.lol I wish at time we could sit with the radiologist to get a better understanding of the exams we are preforming and why other test may be needed. I do understand y'all are super busy to sit with students. I think a radiologist should do videos, I would watch that in a heart beat. I do love radiology, it is such a interesting field. Hope you have a wonderful day
What about the lower GI bleed patient that is "too unstable for scope, consult surgery". Too unstable for scope but not too unstable for 3 hours of general anesthesia and a colectomy? Love, Your friendly neighborhood general surgeon
We also aren’t doing emergent cases with anesthesia assistance. If a patient is too unstable to tolerate bowel prep then the only option (if there’s no IR) is emergent surgery
