Choose Your Own Adventure: Interactive Case Review and Management of the Acute Upper GI Bleed

This lecture will present the case of a middle-aged patient with an acute upper GI bleed. This case starts at the sending facility with a critically ill but relatively stable patient, outlines the changes the transport crew assessed, the interventions they performed, and follows care through the patient arriving at the receiving facility (and the patient's outcome.) As we walk through the case review, participants will make their own clinical decisions regarding the management of this critically ill patient. The case review (and its questions) are structured in a 'Choose your own adventure' format. In addition to prompting participants to make their own choices regarding clinical management at multiple 'decision points' throughout the case, they will get immediate feedback as to the result of their choices. Along the way, we will review best practices, evidence, and transport strategies for optimal management of this patient (including blood products, medications, vasopressors, and mechanical 'tamponade' devices for upper GI bleed.)

Session Outline:
1. Introduction and Case Presentation (8-12min): Brief introduction to the patient case review and relevant background, instructions regarding the flow of the case presentation, and presentation of the case itself.

2. Choose Your Own Adventure Questions and Discussion (8-10 min): These questions are interspersed throughout the case walk-through at critical decision points in the care of the patient. After each question, we will talk through the 'result' of the various choices, how the choice may affect the patient, and then pair that discussion with a review of relevant best practices or clinical evidence that pertains to those choices.

3. Evidence and Practice Review: (10-12min) Topics would include airway management, the use of blood products (PRBCs, Plasma, Platelets, etc), hemorrhagic shock adjuncts (TXA, Factors, Reversal agents), vasopressors use in this setting (specifically norepinephrine, and vasopressin), adjunct medical management to prevent/reverse coagulopathies, medications infusions specific to GI bleed (octreotide, pantoprazole), as well as the roll and subsequent management of devices to provide mechanical or balloon tamponade of bleeding varices.