Date of Issue: 07/01/2019
SUBJECT:GI BleedingPURPOSE:To clearly establish the Department’s position on the clinical care and treatment of patients suffering from GI Bleeding.SCOPE: This Operating Guideline shall be applicable to all personnel; paid and volunteer, operating as an agent of Shamong EMS.RESPONSIBILITY:All Department Officers will ensure overall compliance with this operating guideline. The primary responsibility of the emergency care and treatment of medical and trauma patients falls under Emergency Medical Technicians, paid and volunteer, operating as an agent of Shamong EMS PROCEDURE:Assessment Perform complete primary and secondary assessment, including obtaining a complete set of manual vital signs. ?Assess for signs/symptoms of shock.For upper GI bleeding: Determine history exists of peptic ulcer disease, gastritis, esophagitis, tumors, esophageal varicies, alcohol abuse, or excessive vomiting.Assess for epigastric or LUQ abdominal pain; Assess for vomiting with either red blood or coffee-ground consistency.Assess for dark, tarry stools, increasing frequency of bowel?movements, melanotic diarrhea.For lower GI bleeding:Determine history exists of diverticulosis, tumors, hemorrhoids, rectal fissures. Assess for rectal bleeding, either bright red or wine-colored.Bright red blood: hemorrhoids.Dark red blood: GI Bleed.Assess for cramps, diffuse abdominal pain. Treatment Assess and maintain appropriate airway management.Administer and maintain appropriate dose of oxygen based on patient’s condition.?Reassess vital signs and condition of the patient.Documentation History of bleeding disorders that can cause prolonged or difficult to control bleeding. (Examples include: Thrombocytopenia, Van Willebrands Disease, Hemophilia A/B, etc.)Be sure to ask, and document any current or recent blood thinners. (Common blood thinners include: Aspirin, Coumadin, Warfarin, Heparin, Lovenox, Plavix, Pradaxa.)Duration of bleeding and approximate blood lost.How long has the patient been bleeding.If the patient has a towel or bandage to their wound, its good to include the approx. size and surface area saturated.Cause of bleeding.Was there trauma involved: (ie., fall, laceration, MVA, fight, etc.)Was the bleeding spontaneous?If the bleeding is still active upon arrival be sure to document all methods use to stop the bleeding.If multiple gauze were used be sure to document how many and the frequency applied.EnforcementFailed compliance with the policy and procedures outlined in this document may result in the employee’s entry to the department’s progressive counseling and discipline process. ................
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