WEBVTT
00:00:12.720 --> 00:00:18.160
Acute GI bleeding is one of those ICU situations where everything happens quickly.
00:00:18.480 --> 00:00:22.399
Patients can deteriorate within minutes, and the team has to act fast.
00:00:23.039 --> 00:00:26.000
Managing these cases isn't only about procedures.
00:00:26.320 --> 00:00:30.320
Medication decisions and supportive care are just as critical.
00:00:30.719 --> 00:00:40.000
In today's episode, we will explore how critical care pharmacists and gastroentrologists work together to manage these life-threatening situations in the ICE.
00:00:40.560 --> 00:00:42.000
So today I'm joined by Dr.
00:00:42.079 --> 00:00:46.399
Nagle Marzou, a tropical disease and gastroentrology consultant.
00:00:46.640 --> 00:00:47.280
Hello, Dr.
00:00:47.359 --> 00:00:48.960
Nagle Ramadan Karim.
00:00:49.119 --> 00:00:52.799
Thanks a lot for being with us at the IVP and Critical Care Podcast.
00:00:53.679 --> 00:00:56.799
Hello, my Ramadan Karim, to you too.
00:00:57.039 --> 00:00:59.280
Thank you for inviting me.
00:00:59.439 --> 00:01:09.760
Actually, GIT bleeding is multidisciplinary emergency, and pharmacists play a bigger role than many people realize.
00:01:10.319 --> 00:01:11.280
Yeah, absolutely.
00:01:11.439 --> 00:01:12.640
I totally agree.
00:01:12.879 --> 00:01:19.040
So in the ICU, we really see how every discipline contributes to stabilizing the patient.
00:01:19.359 --> 00:01:23.439
So let's start from the very beginning of the clinical scenario.
00:01:23.599 --> 00:01:32.400
A patient arrives to the ICU with hematempsis, with melina, unstable vitals, and maybe a rapidly dropping hemoglobin.
00:01:32.560 --> 00:01:38.959
So from your perspective as a gastroenterologist, what are the first priorities at that moment?
00:01:40.879 --> 00:01:54.719
When a patient present with acute gastrointestinal bleeding, the first priority is rapid stabilization using the ABC approach, which is airway, breathing, and circulation.
00:01:55.200 --> 00:02:02.400
In practice, circulation and early preparation for hematemes are especially critical.
00:02:02.879 --> 00:02:12.800
First, we should assess the airway if the patient has massive hematemesis, altered consciousness, or cannot protect their airway.
00:02:13.520 --> 00:02:19.280
Early help should be called and intuition should be considered immediately.
00:02:22.719 --> 00:02:29.280
Provide oxygen support if needed and place the patient on continuous monitoring.
00:02:29.840 --> 00:02:43.680
The focus on circulation, which is often the most urgent issue, look for signs of shock, such as tachycardia, hypotension, or altered mental status.
00:02:44.240 --> 00:02:54.960
Once initial stabilization is underway, urgent endoscopy should be arranged, particularly in unstable GIT reading, often within hours.
00:02:55.840 --> 00:03:08.159
And at this critical point, I usually not the pharmacist ensuring that all medication given are clearly documented.
00:03:08.479 --> 00:03:18.319
And that electronic orders are updated, and the entire health care team is working from the same treatment plan.
00:03:19.840 --> 00:03:20.879
Yeah, exactly.
00:03:20.960 --> 00:03:26.159
And that moment is usually where form seasons end very early.
00:03:26.479 --> 00:03:35.759
So yeah, we immediately start reviewing the medication history of the patient because many ICU bleeds are actually medication triggered or medication worsened.
00:03:36.319 --> 00:03:55.439
So we usually quickly review the anticoagulants, the antiplatelets, maybe the non-steroidal drugs, any recent thrombolytics, any recent TPA altiplasis the patient had taken, any drug interactions that can worsen or increase the bleeding risk.
00:03:55.599 --> 00:03:59.840
And sometimes that medication review completely changes the management plan.
00:04:00.319 --> 00:04:11.039
So, from your experience, how often do you find that drug-related risk factors are underrecognized before pharmacy intervention?
00:04:12.479 --> 00:04:25.519
Actually, it is very frequently many clinicians focus mainly on procedures to control the source of bleeding, but the pharmacological issues are often underestimated.
00:04:25.920 --> 00:04:48.800
In my experience, reviewing hundreds of gastro-intestinal leading causes in ICU, drug-related risk factors such as monesteroidal anti-inflammatory drugs, anti-coagulant, anti-platelet, SSRI are either under recognized or not addressed.
00:04:49.040 --> 00:04:55.600
In about 60 to 80 percentage of the patients before pharmacy intervention.
00:04:56.639 --> 00:05:13.199
Clinical pharmacists play a key role in preventing EGI bleeding by identifying and intervening early on high-risk medication and inappropriate prophylaxis in ICU sitting.
00:05:14.639 --> 00:05:16.639
Yeah, that's a very important point.
00:05:17.040 --> 00:05:24.160
Because once endoscopic control is achieved, the next question often becomes pharmacologic management moving forward.
00:05:24.720 --> 00:05:33.759
So one of the ongoing discussions in critical care is the optimal PPI dosing strategy after endoscopic hemostasis.
00:05:34.000 --> 00:05:41.839
So there has been a lot and there has been increasing debate about continuous infusion versus the intermittent polous therapy.
00:05:42.000 --> 00:05:48.399
So how do you personally interpret the evolving literature surrounding those PPI dosing strategies?
00:05:49.519 --> 00:05:50.959
Yes, you are right.
00:05:51.199 --> 00:06:10.240
The evolving literature supports intermittent polous DBI therapy as non-inferior to continuous infusion after endoscopic hemostasis for high-risk group in ARGI bleeding ulcers.
00:06:11.199 --> 00:06:24.480
This shift is supported by meta-analysis on the current guidelines showing that similar clinical outcomes can be achieved while using few or health care resources.
00:06:26.720 --> 00:06:33.519
High dose BBI therobic is recommended for the first three days after successful hemostasis.
00:06:33.680 --> 00:06:51.680
This can be given either continuous infusion, for example, 80 milligram bolus followed by 8 milligrams per hour, or intermittent dosing, such as 40 IV every 12 to 24 hours.
00:06:51.920 --> 00:07:06.800
Evidence suggests that in selected low-risk patients, intermittent high dose of BBI after successful endoscopic hemostasis can provide outcomes comparable to continuous infusion.
00:07:07.120 --> 00:07:23.680
However, for patients with high-risk lesions, such as active bleeding ulcer or visible visals during endoscopy, I still prefer continuous infusion during the first 72 hours.
00:07:24.480 --> 00:07:48.639
Actually, pharmacists provide valuable patient-specific assessment by evaluating bleeding severity, comorbid conditions, and medication absorption reliability in clinical ear in critical ill patient.
00:07:49.920 --> 00:08:09.600
Additionally, ICU pharmacist monitoring BBI associated complications, such as uh cholesteridium deficiel infection, um ventilator associated pneumonia, VAB, risk, particularly in prolonged ICU steps.
00:08:10.399 --> 00:08:11.279
Yeah, exactly.
00:08:11.360 --> 00:08:11.680
Yeah.
00:08:11.839 --> 00:08:24.639
And we usually also review the medication for it, not only for the acute treatment, but we also look for the longer treatment or the long-side effects of the longer uh duration of PPO therapy.
00:08:25.120 --> 00:08:32.879
So um now I would like to move to the discussion for another very challenging scenario, which is the varicyl hemorrhage.
00:08:33.759 --> 00:08:42.559
So uh because of varicyl bleeding, um, multiple pharmacologic decisions often need to happen simultaneously, like all at once.
00:08:42.799 --> 00:08:54.879
So in our ICU practice, initiating a vasoactive therapy, uh, an antibiotic prophylaxis, hemodynamic monitoring often all occurs almost at the same time.
00:08:55.200 --> 00:09:05.200
So, um, from a gastroenterology standpoint, which medication decision most significantly influences the survival rate in varicel bleeding?
00:09:07.360 --> 00:09:15.759
Actually, in acute varicelle bleeding, vasoactive therapy plays a major role in improving survival.
00:09:17.360 --> 00:09:32.639
Currently, guidelines recommend starting a vasoactive medication such as teleprison or somatostatin, as soon as varical bleeding is suspected.
00:09:33.200 --> 00:09:42.399
These uh drugs help by lowering portal pressure, controlling the bleeding and improving short-term outcomes.
00:09:42.720 --> 00:09:50.720
Antibiotics, secondary antibiotics, also has an essential part of management.
00:09:50.879 --> 00:10:00.399
Their main role to prevent infections and the scobi, which are common in these uh patients.
00:10:00.799 --> 00:10:11.759
Yeah, and that and actually that leads us to the one of the most clinical complex decisions we usually face in ICU patients, which is the anticoagulant reversal.
00:10:12.080 --> 00:10:20.960
So reversing anticoagulation can reduce, of course, the hemorrhage progression, but at the same time, it increases the risk of thrombosis.
00:10:21.200 --> 00:10:29.759
So in multidisciplinary discussions, pharmacists often lead the you know the pharmacokinetic interpretation of these medications.
00:10:30.000 --> 00:10:38.879
But how do you approach the timing of anticoagulant or maybe of an antiplatelet reversal relative to the endoscopy, of course?
00:10:39.360 --> 00:10:39.919
Yes.
00:10:40.159 --> 00:10:50.000
Um when managing the bleeding in patients on anticoagulant, timing of reversal should be guided by pharmacokinetis.
00:10:51.679 --> 00:11:01.200
Reversal agents should be generally reserved for life-threatening the bleeding or severe ongoing hemorrhage.
00:11:01.679 --> 00:11:06.799
And importantly, they should not delay urgent endoscopy.
00:11:08.639 --> 00:11:09.279
Yes.
00:11:10.399 --> 00:11:19.120
Current guidelines, hemodynamic stabilization and early endoscopic evaluation, ideally.
00:11:19.679 --> 00:11:28.480
Within, for example, within uh 12 hours for suspected paracelin or within 24 hours for other cases.
00:11:29.039 --> 00:11:40.639
Initial management should be focused on resuscitation, targeting hemoglobin living between 7 to 9 grams.
00:11:40.799 --> 00:11:57.759
At the same time, we start uh appropriate pharmacological therapy such as vasoactive agents for suspected perical bleeding, BBI for non-periceal bleeding, antibiotic, as mentioned before.
00:11:58.080 --> 00:12:10.720
Lapt is to guide reversal decisions such as INR ABTT levels, depend on anticoagulant involved.
00:12:11.360 --> 00:12:18.559
After successful hemostasis, anticoagulant is usually restart within three to seven days.
00:12:19.519 --> 00:12:32.480
Although patients with a very high thrombotic risk may require early resumes within less than uh three days.
00:12:33.200 --> 00:12:34.159
Yeah, exactly.
00:12:34.320 --> 00:12:39.440
So because delaying anticoagulation, of course, increases the stroke and thrombosis risk.
00:12:39.600 --> 00:12:43.519
So, particularly in those patients with a high CHADS bask score.
00:12:44.639 --> 00:12:55.200
Yes, yes, the balance between bleeding and the thrombosis is one of the most challenging parts of managing these patients.
00:12:55.679 --> 00:13:00.480
This is where collaboration of the pharmacists become extremely bad.
00:13:01.200 --> 00:13:02.559
Oh, thank you.
00:13:02.960 --> 00:13:03.600
Yes.
00:13:04.240 --> 00:13:12.879
So um before we close, um, can we summarize um maybe three high-impact clinical pairs in acute GI bleeding?
00:13:13.200 --> 00:13:14.399
Yes, okay.
00:13:14.799 --> 00:13:20.159
Um first, um stabilization comes first.
00:13:20.799 --> 00:13:33.679
In acute GI bleeding, rapid resuscitation, hemodynamic stabilization, and the timely endoscopic evaluation are essential to prevent deterioration and improved outcomes.
00:13:34.480 --> 00:13:41.360
Secondly, medication plays a major role in both uh the cause and the treatment of bleeding.
00:13:41.600 --> 00:14:07.440
Carefully, anticoagulant, antiplatelet, and other high risk drugs such as nanisteroidal anti-inflammatory drugs is crucial, while appropriate pharmacologic therapy, including BBI, vasoactive agents, antibiotics, and transfusion strategies support successive bleeding control.
00:14:08.080 --> 00:14:14.159
Number three, multidisciplinary collaboration, improve patients' outcome.
00:14:14.480 --> 00:14:34.159
Managing VGIT bleeding and ICU required coordination care between gastroenterologists, inter civilists, pharmacists, and the wider healthcare team to balance bleeding control from both risk and overall patient safety.
00:14:34.480 --> 00:14:40.240
Yeah, we usually all focus on the uh overall patient safety, and I totally agree.
00:14:40.480 --> 00:14:41.600
So, um, Dr.
00:14:41.759 --> 00:14:45.519
Najla, uh, thank you for sharing your expertise with us today.
00:14:45.759 --> 00:14:56.000
I have now no doubt that managing the acute GOI bleeding patients is one of the clearest examples of um why ICU care must be a multidisciplinary.
00:14:57.120 --> 00:14:59.200
Yes, yes, totally agree.
00:14:59.279 --> 00:15:00.240
Thank you, Umai.
00:15:00.320 --> 00:15:01.679
It's my pleasure.
00:15:02.000 --> 00:15:07.759
Yes, thank you to our listeners for joining us today on the IVPN Critical Care podcast.
00:15:08.159 --> 00:15:13.919
Stay tuned for our next episode where we continue exploring critical care topics.
00:00:12.720 --> 00:00:18.160
Acute GI bleeding is one of those ICU situations where everything happens quickly.
00:00:18.480 --> 00:00:22.399
Patients can deteriorate within minutes, and the team has to act fast.
00:00:23.039 --> 00:00:26.000
Managing these cases isn't only about procedures.
00:00:26.320 --> 00:00:30.320
Medication decisions and supportive care are just as critical.
00:00:30.719 --> 00:00:40.000
In today's episode, we will explore how critical care pharmacists and gastroentrologists work together to manage these life-threatening situations in the ICE.
00:00:40.560 --> 00:00:42.000
So today I'm joined by Dr.
00:00:42.079 --> 00:00:46.399
Nagle Marzou, a tropical disease and gastroentrology consultant.
00:00:46.640 --> 00:00:47.280
Hello, Dr.
00:00:47.359 --> 00:00:48.960
Nagle Ramadan Karim.
00:00:49.119 --> 00:00:52.799
Thanks a lot for being with us at the IVP and Critical Care Podcast.
00:00:53.679 --> 00:00:56.799
Hello, my Ramadan Karim, to you too.
00:00:57.039 --> 00:00:59.280
Thank you for inviting me.
00:00:59.439 --> 00:01:09.760
Actually, GIT bleeding is multidisciplinary emergency, and pharmacists play a bigger role than many people realize.
00:01:10.319 --> 00:01:11.280
Yeah, absolutely.
00:01:11.439 --> 00:01:12.640
I totally agree.
00:01:12.879 --> 00:01:19.040
So in the ICU, we really see how every discipline contributes to stabilizing the patient.
00:01:19.359 --> 00:01:23.439
So let's start from the very beginning of the clinical scenario.
00:01:23.599 --> 00:01:32.400
A patient arrives to the ICU with hematempsis, with melina, unstable vitals, and maybe a rapidly dropping hemoglobin.
00:01:32.560 --> 00:01:38.959
So from your perspective as a gastroenterologist, what are the first priorities at that moment?
00:01:40.879 --> 00:01:54.719
When a patient present with acute gastrointestinal bleeding, the first priority is rapid stabilization using the ABC approach, which is airway, breathing, and circulation.
00:01:55.200 --> 00:02:02.400
In practice, circulation and early preparation for hematemes are especially critical.
00:02:02.879 --> 00:02:12.800
First, we should assess the airway if the patient has massive hematemesis, altered consciousness, or cannot protect their airway.
00:02:13.520 --> 00:02:19.280
Early help should be called and intuition should be considered immediately.
00:02:22.719 --> 00:02:29.280
Provide oxygen support if needed and place the patient on continuous monitoring.
00:02:29.840 --> 00:02:43.680
The focus on circulation, which is often the most urgent issue, look for signs of shock, such as tachycardia, hypotension, or altered mental status.
00:02:44.240 --> 00:02:54.960
Once initial stabilization is underway, urgent endoscopy should be arranged, particularly in unstable GIT reading, often within hours.
00:02:55.840 --> 00:03:08.159
And at this critical point, I usually not the pharmacist ensuring that all medication given are clearly documented.
00:03:08.479 --> 00:03:18.319
And that electronic orders are updated, and the entire health care team is working from the same treatment plan.
00:03:19.840 --> 00:03:20.879
Yeah, exactly.
00:03:20.960 --> 00:03:26.159
And that moment is usually where form seasons end very early.
00:03:26.479 --> 00:03:35.759
So yeah, we immediately start reviewing the medication history of the patient because many ICU bleeds are actually medication triggered or medication worsened.
00:03:36.319 --> 00:03:55.439
So we usually quickly review the anticoagulants, the antiplatelets, maybe the non-steroidal drugs, any recent thrombolytics, any recent TPA altiplasis the patient had taken, any drug interactions that can worsen or increase the bleeding risk.
00:03:55.599 --> 00:03:59.840
And sometimes that medication review completely changes the management plan.
00:04:00.319 --> 00:04:11.039
So, from your experience, how often do you find that drug-related risk factors are underrecognized before pharmacy intervention?
00:04:12.479 --> 00:04:25.519
Actually, it is very frequently many clinicians focus mainly on procedures to control the source of bleeding, but the pharmacological issues are often underestimated.
00:04:25.920 --> 00:04:48.800
In my experience, reviewing hundreds of gastro-intestinal leading causes in ICU, drug-related risk factors such as monesteroidal anti-inflammatory drugs, anti-coagulant, anti-platelet, SSRI are either under recognized or not addressed.
00:04:49.040 --> 00:04:55.600
In about 60 to 80 percentage of the patients before pharmacy intervention.
00:04:56.639 --> 00:05:13.199
Clinical pharmacists play a key role in preventing EGI bleeding by identifying and intervening early on high-risk medication and inappropriate prophylaxis in ICU sitting.
00:05:14.639 --> 00:05:16.639
Yeah, that's a very important point.
00:05:17.040 --> 00:05:24.160
Because once endoscopic control is achieved, the next question often becomes pharmacologic management moving forward.
00:05:24.720 --> 00:05:33.759
So one of the ongoing discussions in critical care is the optimal PPI dosing strategy after endoscopic hemostasis.
00:05:34.000 --> 00:05:41.839
So there has been a lot and there has been increasing debate about continuous infusion versus the intermittent polous therapy.
00:05:42.000 --> 00:05:48.399
So how do you personally interpret the evolving literature surrounding those PPI dosing strategies?
00:05:49.519 --> 00:05:50.959
Yes, you are right.
00:05:51.199 --> 00:06:10.240
The evolving literature supports intermittent polous DBI therapy as non-inferior to continuous infusion after endoscopic hemostasis for high-risk group in ARGI bleeding ulcers.
00:06:11.199 --> 00:06:24.480
This shift is supported by meta-analysis on the current guidelines showing that similar clinical outcomes can be achieved while using few or health care resources.
00:06:26.720 --> 00:06:33.519
High dose BBI therobic is recommended for the first three days after successful hemostasis.
00:06:33.680 --> 00:06:51.680
This can be given either continuous infusion, for example, 80 milligram bolus followed by 8 milligrams per hour, or intermittent dosing, such as 40 IV every 12 to 24 hours.
00:06:51.920 --> 00:07:06.800
Evidence suggests that in selected low-risk patients, intermittent high dose of BBI after successful endoscopic hemostasis can provide outcomes comparable to continuous infusion.
00:07:07.120 --> 00:07:23.680
However, for patients with high-risk lesions, such as active bleeding ulcer or visible visals during endoscopy, I still prefer continuous infusion during the first 72 hours.
00:07:24.480 --> 00:07:48.639
Actually, pharmacists provide valuable patient-specific assessment by evaluating bleeding severity, comorbid conditions, and medication absorption reliability in clinical ear in critical ill patient.
00:07:49.920 --> 00:08:09.600
Additionally, ICU pharmacist monitoring BBI associated complications, such as uh cholesteridium deficiel infection, um ventilator associated pneumonia, VAB, risk, particularly in prolonged ICU steps.
00:08:10.399 --> 00:08:11.279
Yeah, exactly.
00:08:11.360 --> 00:08:11.680
Yeah.
00:08:11.839 --> 00:08:24.639
And we usually also review the medication for it, not only for the acute treatment, but we also look for the longer treatment or the long-side effects of the longer uh duration of PPO therapy.
00:08:25.120 --> 00:08:32.879
So um now I would like to move to the discussion for another very challenging scenario, which is the varicyl hemorrhage.
00:08:33.759 --> 00:08:42.559
So uh because of varicyl bleeding, um, multiple pharmacologic decisions often need to happen simultaneously, like all at once.
00:08:42.799 --> 00:08:54.879
So in our ICU practice, initiating a vasoactive therapy, uh, an antibiotic prophylaxis, hemodynamic monitoring often all occurs almost at the same time.
00:08:55.200 --> 00:09:05.200
So, um, from a gastroenterology standpoint, which medication decision most significantly influences the survival rate in varicel bleeding?
00:09:07.360 --> 00:09:15.759
Actually, in acute varicelle bleeding, vasoactive therapy plays a major role in improving survival.
00:09:17.360 --> 00:09:32.639
Currently, guidelines recommend starting a vasoactive medication such as teleprison or somatostatin, as soon as varical bleeding is suspected.
00:09:33.200 --> 00:09:42.399
These uh drugs help by lowering portal pressure, controlling the bleeding and improving short-term outcomes.
00:09:42.720 --> 00:09:50.720
Antibiotics, secondary antibiotics, also has an essential part of management.
00:09:50.879 --> 00:10:00.399
Their main role to prevent infections and the scobi, which are common in these uh patients.
00:10:00.799 --> 00:10:11.759
Yeah, and that and actually that leads us to the one of the most clinical complex decisions we usually face in ICU patients, which is the anticoagulant reversal.
00:10:12.080 --> 00:10:20.960
So reversing anticoagulation can reduce, of course, the hemorrhage progression, but at the same time, it increases the risk of thrombosis.
00:10:21.200 --> 00:10:29.759
So in multidisciplinary discussions, pharmacists often lead the you know the pharmacokinetic interpretation of these medications.
00:10:30.000 --> 00:10:38.879
But how do you approach the timing of anticoagulant or maybe of an antiplatelet reversal relative to the endoscopy, of course?
00:10:39.360 --> 00:10:39.919
Yes.
00:10:40.159 --> 00:10:50.000
Um when managing the bleeding in patients on anticoagulant, timing of reversal should be guided by pharmacokinetis.
00:10:51.679 --> 00:11:01.200
Reversal agents should be generally reserved for life-threatening the bleeding or severe ongoing hemorrhage.
00:11:01.679 --> 00:11:06.799
And importantly, they should not delay urgent endoscopy.
00:11:08.639 --> 00:11:09.279
Yes.
00:11:10.399 --> 00:11:19.120
Current guidelines, hemodynamic stabilization and early endoscopic evaluation, ideally.
00:11:19.679 --> 00:11:28.480
Within, for example, within uh 12 hours for suspected paracelin or within 24 hours for other cases.
00:11:29.039 --> 00:11:40.639
Initial management should be focused on resuscitation, targeting hemoglobin living between 7 to 9 grams.
00:11:40.799 --> 00:11:57.759
At the same time, we start uh appropriate pharmacological therapy such as vasoactive agents for suspected perical bleeding, BBI for non-periceal bleeding, antibiotic, as mentioned before.
00:11:58.080 --> 00:12:10.720
Lapt is to guide reversal decisions such as INR ABTT levels, depend on anticoagulant involved.
00:12:11.360 --> 00:12:18.559
After successful hemostasis, anticoagulant is usually restart within three to seven days.
00:12:19.519 --> 00:12:32.480
Although patients with a very high thrombotic risk may require early resumes within less than uh three days.
00:12:33.200 --> 00:12:34.159
Yeah, exactly.
00:12:34.320 --> 00:12:39.440
So because delaying anticoagulation, of course, increases the stroke and thrombosis risk.
00:12:39.600 --> 00:12:43.519
So, particularly in those patients with a high CHADS bask score.
00:12:44.639 --> 00:12:55.200
Yes, yes, the balance between bleeding and the thrombosis is one of the most challenging parts of managing these patients.
00:12:55.679 --> 00:13:00.480
This is where collaboration of the pharmacists become extremely bad.
00:13:01.200 --> 00:13:02.559
Oh, thank you.
00:13:02.960 --> 00:13:03.600
Yes.
00:13:04.240 --> 00:13:12.879
So um before we close, um, can we summarize um maybe three high-impact clinical pairs in acute GI bleeding?
00:13:13.200 --> 00:13:14.399
Yes, okay.
00:13:14.799 --> 00:13:20.159
Um first, um stabilization comes first.
00:13:20.799 --> 00:13:33.679
In acute GI bleeding, rapid resuscitation, hemodynamic stabilization, and the timely endoscopic evaluation are essential to prevent deterioration and improved outcomes.
00:13:34.480 --> 00:13:41.360
Secondly, medication plays a major role in both uh the cause and the treatment of bleeding.
00:13:41.600 --> 00:14:07.440
Carefully, anticoagulant, antiplatelet, and other high risk drugs such as nanisteroidal anti-inflammatory drugs is crucial, while appropriate pharmacologic therapy, including BBI, vasoactive agents, antibiotics, and transfusion strategies support successive bleeding control.
00:14:08.080 --> 00:14:14.159
Number three, multidisciplinary collaboration, improve patients' outcome.
00:14:14.480 --> 00:14:34.159
Managing VGIT bleeding and ICU required coordination care between gastroenterologists, inter civilists, pharmacists, and the wider healthcare team to balance bleeding control from both risk and overall patient safety.
00:14:34.480 --> 00:14:40.240
Yeah, we usually all focus on the uh overall patient safety, and I totally agree.
00:14:40.480 --> 00:14:41.600
So, um, Dr.
00:14:41.759 --> 00:14:45.519
Najla, uh, thank you for sharing your expertise with us today.
00:14:45.759 --> 00:14:56.000
I have now no doubt that managing the acute GOI bleeding patients is one of the clearest examples of um why ICU care must be a multidisciplinary.
00:14:57.120 --> 00:14:59.200
Yes, yes, totally agree.
00:14:59.279 --> 00:15:00.240
Thank you, Umai.
00:15:00.320 --> 00:15:01.679
It's my pleasure.
00:15:02.000 --> 00:15:07.759
Yes, thank you to our listeners for joining us today on the IVPN Critical Care podcast.
00:15:08.159 --> 00:15:13.919
Stay tuned for our next episode where we continue exploring critical care topics.
