Management (general and specific)
The management of children presenting with LGIB to the emergency department is of course hugely dependent on clinical assessment of the child and what the suspected cause of the bleeding is. Following A-E assessment, if the child is in hypovolaemic shock with a lower GI bleed then resuscitation will be required:
- Insert 2 large bore cannulae and take bloods: FBC, U&E, CRP, Coagulation, LFTs, group and save, and a VBG
- Initial fluid bolus of 10ml/kg, consider resuscitating with blood if available
- Reassess and repeat fluid bolus as indicated
- If they remain shocked, give 5ml/kg packed red cells as boluses alongside FFP at a 1:1 ratio
- If still shocked after 20ml/kg blood products then give 10ml/kg platelets and 0.1 ml/kg 10% calcium chloride8 – as always follow your local Trust guidance
Following initial assessment and stabilisation then the history and examination can be taken. This will help determine whether the child requires admission, or whether they can be discharged and if an outpatient appointment is required.