Podcast #169 - EM ID: Upper GI Bleeding, Antibiotics, and Fecal Transplants for C. diff

Patrick Bafuma handed over the reigns for this month's EM ID series to Dr. Gita Pensa with Brown University.  She  interviewed Dr. Colleen Kelly who is a gastroenterologist and also teaches at Brown.  In this podcast they talk about two very common GI complaints where antibiotics play a role: upper GI bleeding and C. diff infections.

This is a shorter podcast full of great details.  Make sure to listen to it but here are some of the highlights.

In acute upper GI bleeding add antibiotics for any patient with cirrhosis (whether or not ascites is present):

• Can significantly help decrease mortality (20% decrease)
• Give early in the course of management
• Consider spontaneous bacterial peritonitis (SBP) as it can be asymptomatic

C. diff Infection Management:

• For a quick recap of some general management, check out our recent podcast (#167)
• It can take 4-5 days to have some response to the oral antibiotics given on diagnosis
• Severe infections can carry a higher mortality rate and should be admitted
• Fecal transplant can be 85-90% successful after a single dose
  • Often being considered after three episodes or two severe cases
  • Considered earlier in management now versus being a last resort
  • There are donor banks that are now available
  • Main method of management now is colonoscopy instead of delivered through upper GI track

Do you like what you heard?  Check out another podcast that Dr. Gita Pensa has created called Doctors and Litigation: The L Word  as well as Academy Emergency Medicine (AEM) Early Access Podcast which she is the editor/producer and host. 

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and  on iTunes.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.

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