Untreated Gastrointestinal Bleed Leads to Cardiac Arrest

This case involves a thirty-one-year-old female patient who presented to the hospital with complaints of severe upper-right quadrant pain, vomiting, and dark blood in her stool. A week prior to her admission, the patient had an abdominal ultrasound at her PCP that was read as normal. One week before her admission the patient experienced coffee-ground emesis and the inability to tolerate anything by mouth. The patient experienced a severely hypotensive episode a few hours after her admission but no fluids or blood products were considered in her treatment regimen. The patient became unresponsive shortly after and a code was called. The cause of death was cardiac arrest secondary to a large gastrointestinal bleed.

Question(s) For Expert Witness

1. How should this patient have been managed to prevent the shock and arrest?

Expert Witness Response

In this particular case, the patient should have immediately gotten IV fluids as she was presenting with hypotension. Patients who suffer from severe blood loss have hemorrhagic shock, which presents with mental status changes. Oftentimes patients cannot protect their airway, and they should be electively intubated. As mentioned before, intravenous access must be obtained immediately for volume resuscitative efforts. Once stabilized it would be worthwhile to consult gastroenterology for an EGD to assess for bleeding and concomitantly get an abdominal CT scan to evaluate for intraperitoneal bleeding.