Save yourselves a blood transfusion. Being a direct witness of this I want to warn you about a practice that is taking place way too often. Gastro intestinal bleeds, AKA GI bleeds, are one of the most mismanaged conditions in medicine. Read all about it in these articles below.
1. Make sure that as soon as your Diagnosis is made, and that takes being proactive, let your Doctor know that you want to have a Gastroenterologist do an endoscopy right away.
2.If they say that there is no one on call. Ask for a transfer to a facility that has that support. Under federal law EMTALA that is your right. Yes insist on this and quote the above EMTALA! Every Health care worker squirms at the sound of that word.
Treatment
Emergency treatment for upper GI bleeds includes aggressive replacement of volume with
intravenous solutions, and
blood products if required
:c onfused:. As patients with
esophageal varices typically have coagulopathy,
plasma products may have to be administered. Vitals signs are continuously monitored.
Early endoscopy is recommended, both as a diagnostic and therapeutic approach, as endoscopic treatment can be performed through the endoscope. Therapy depends on the lesion identifies, and can include:Stigmata of high risk include active bleeding, oozing, visible vessels and red spots. Clots that are present on the bleeding lesion are usually removed in order to determine the underlying pathology, and to determine the risk for rebleeding.
Pharmacotherapy includes the following:
- Proton pump inhibitors (PPIs), which reduce gastric acid production and accelerate healing of certain gastric, duodenal and esophageal sources of hemorrhage. These can be administered orally or intravenously as an infusion depending on the risk of rebleeding.
- Octreotide is a somatostatin analog believed to shunt blood away from the splanchnic circulation. It has found to be a useful adjunct in management of both variceal and non-variceal upper GI hemorrhage. It is the somatostatin analog most commonly used in North America.
- Terlipressin is a somatostatin analog most commonly used in Europe for variceal upper GI hemorrhage.
- Antibiotics are prescribed in upper GI bleeds associated with portal hypertension
If
Helicobacter pylori is identified as a contributant to the source of hemorrhage, then therapy with antibiotics and a PPI is suggested.
13 Specialists Quit Hospital Over On-call Issues Following EMTALA Citation
Updating previous report --see related article below on the Medlaw.com home page.
By
Stephen A. Frew JD
Posted Wednesday, February 14, 2007
Updating previous report --see related article below on the Medlaw.com home page.
13 ED MDs quit over compensation issue
Thirteen gastroenterologists of the Loxahatchee, FL, Palms West Hospital quit practicing at the hospital February 1, when their demands for $1,000 per day on-call stipend were refused by the hospital. As reported in a prior January article, the hospital was one of three cited for failing to treat an uninsured patient with internal bleeding.
Area papers report that out of 92 gastroenterologists in the county, fewer than 20 treat emergency cases, and most of the debate originally centered on payment for call. Following the citation, which treatened the three cited hospitals with loss of all federal reimbursement for failure to have specialty services on call, the rhetoric changed somewhat to talk of "fear of getting sued" by emergency department patients.
A real "smoking gun" disclosure about the real fear of suit, however, surfaced in the Palm Beach Post on February 2, when the paper revealed that most of the county's specialists had dropped their malpractice insurance, allegedly due to costs. Florida is one of the few states that specifically allows physicians to "go bare" and practice without liability insurance.
Many states do not specifically require physicians to carry malpractice insurance, but most hospitals outside of Florida require physicians to maintain specific levels of malpractice coverage through approved insurers. Without physician insurance, hospitals fear that they will become the "deep pockets" defendant in liability claims against any physician.
In states with government run patient compensation systems, such as Wisconsin and Nebraska, which handle catastrophic losses, laws generally require physicians to maintain minimum levels of underlying insurance to quality for state protection.
With federal EMTALA and Florida state legal requirements that mandate hospitals to assure that on-call physicians are available to back-up the Emergency Department in providing assessment and care to emergency patients, questions about the legality of stipends for being on-call, and prohibition against collective actions by physicians under Federal anti-trust laws, the actions of the physicians to avoid call and the "coincidence" of virtually all specialists deciding "individually" to go without insurance coverage, the situation in Palm County is starting to resemble an old-fashion shoot-out between physicians and hospitals that could be an indicator of things to come across the country where all hospitals are potentially facing variations of the same theme.
On the physician's side, the Florida law on insurance seems to be an extra advantage over most states, and the fact that the physicians' may be able to practice successfully without hospital privileges gives them an advantage, but if courts or regulators find that there is "collective action" by physicians, major lawsuits and even potential criminal charges.
On the hospital's side of the battle, federal law doesn't give the hospital any option of allowing specialties to avoid being on-call.
While it remains uncertain who will win this shoot-out, a lot innocent patients may die or be injured before the matter is resolved, and some physician practices and hospitals may close in the process.
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