# rectile bleeding



## nevets_eural (Aug 16, 2011)

during clinicals in basic had a call for severe rectile bleedind, well we got there and the patient apparently had a history of it(dont remember the cause) so we just took his word for it and transported,       now i didnt personally want to look at his butt...... but was that the correct thing to do


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## medichopeful (Aug 16, 2011)

nevets_eural said:


> during clinicals in basic had a call for severe rectile bleedind, well we got there and the patient apparently had a history of it(dont remember the cause) so we just took his word for it and transported,       now i didnt personally want to look at his butt...... but was that the correct thing to do



If you just threw him on the stretcher and transported him, no, that wouldn't have been correct.

Even though he had a history of this, you still need to take a good history and conduct a good patient interview.  Did you do this and take vitals?

The decision about whether to look or not at something so personal is one that I won't tell you whether was right or wrong here.  I wasn't there, and that's something that really depends on the situation (read: how the patient felt).


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## Smash (Aug 16, 2011)

"Rectal" bleeding.

Some days I don't want to look at another persons face, let alone their posterior, but that's just too bad, it's part of the job.

There's no excuse for not gathering an accurate history and carrying out a physical examination, or for that matter not treating something.


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## JPINFV (Aug 16, 2011)

Is it worth it too look? Depends on what the rest of the exam is and how the patient is characterizing it. To be honest, though, I'm going to go out on a limb and say that prehospitally there's little reason to look, and most likely nothing to see anyways.


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## MrBrown (Aug 16, 2011)

Smash said:


> Some days I don't want to look at another persons face, let alone their posterior, but that's just too bad, it's part of the job.



Come on mate is Brown that ugly? 



Smash said:


> There's no excuse for not gathering an accurate history and carrying out a physical examination, or for that matter not treating something.



Agree!


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## 8jimi8 (Aug 16, 2011)

Unless he's hemorrhaging enough to be seen even with his pants on, do you really need to look at it? what are you going to do?

your treatment includes putting what where?


Just take his word for it, get his history and medications and take him in.


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## Melclin (Aug 16, 2011)

Yeah I think in a lot of cases questioning can do most of the job. Assuming they're able to answer questions and answer them accurately. 

You go to a person who says there was a brief smear of blood on the toilet paper when they wiped 6 hours ago and can reasonably confirm that there was no bleeding since. I'm not sure it requires me get my pen torch out and glove up.

Hopping in the truck and not giving it another thought is not the right answer, but I'm not sure a rectal exam everytime is either.


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## nevets_eural (Aug 16, 2011)

8jimi8 said:


> Unless he's hemorrhaging enough to be seen even with his pants on, do you really need to look at it? what are you going to do?
> 
> your treatment includes putting what where?
> 
> ...



thats what the medics said, we did get base line vitals but that was pretty much it and transported, just been wondering since if we might have not handled the situation correctly but obviously not much we could do in prehospital setting


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## Sasha (Aug 16, 2011)

Chances are the patient doesn't want you looking at his bum anymore than you want to look at it.

Take a minute and think... What are you going to do once you look at it? will it change your treatment? You're not gonna be able to hold pressure on the bleed. 

Preserve their dignity a little, take their word for it, and transport. The only time I've investigated someone's butt is when they had a prolapsed colon, and that was only to get the patient out of the dirty diaper and wrap the protruded colon in a wet dressing.


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## JPINFV (Aug 16, 2011)

Sasha said:


> Take a minute and think... What are you going to do once you look at it? will it change your treatment? You're not gonna be able to hold pressure on the bleed.


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## usafmedic45 (Aug 16, 2011)

The smell alone should be enough to tell you more than you probably need to know in the field.


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## usalsfyre (Aug 16, 2011)

Generally I'll ask if they still feel anything coming out. If yes, I'll look simply because I want an accurate gauge on how much bleeding we're talking about. Otherwise, I'll just leave it alone.


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## hyperlyeman1 (Aug 18, 2011)

JPINFV said:


>



I prefer the rubber corks. the ones you can suction seal


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## LonghornMedic (Aug 20, 2011)

I'm not going to look at his or her butt anymore than I would look at a female patient's vag for a vag bleed. If you can visualize how much blood has been lost on clothes, toilet, bed sheets, etc and/or the patient can tell you how much they have been bleeding and there is no trauma MOI, I don't feel it necessary to look. Get a good history, vitals and so on and treat accordingly.


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## medic417 (Aug 20, 2011)

LonghornMedic said:


> I'm not going to look at his or her butt anymore than I would look at a female patient's vag for a vag bleed. If you can visualize how much blood has been lost on clothes, toilet, bed sheets, etc and/or the patient can tell you how much they have been bleeding and there is no trauma MOI, I don't feel it necessary to look. Get a good history, vitals and so on and treat accordingly.



:rofl:
Failure to look is failure to properly evaluate.  You can not accurately advocate for your patient if you do not actually have any true clue as to amount of bleeding.  Clothes absorb much more than you realize before it shows.  Plus many with history of bleeding will use absorbent pads so you may say no blood noticed but they may have a full pad.


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## LonghornMedic (Aug 21, 2011)

medic417 said:


> :rofl:
> Failure to look is failure to properly evaluate.  You can not accurately advocate for your patient if you do not actually have any true clue as to amount of bleeding.  Clothes absorb much more than you realize before it shows.  Plus many with history of bleeding will use absorbent pads so you may say no blood noticed but they may have a full pad.



Isn't that why we do vitals? If the PT is hypovolemic I can treat that. I can't treat a rectal bleed with pressure. The best I can do is place some gauze in the area to absorb the blood. Other than that, I can treat for the blood loss. If you choose to take a gander at his or her butt, that's your choice. If the bleed is trauma related I would look and I have. I had a 6 year old female who fell in the bathtub and landed on the faucet and it lacerated the area around her anus. The bleeding had stopped prior to arrival. I did visualize the injury and we transported. But if it is a non-traumatic rectal bleed there's nothing to be done to stop it and I will treat any shock as needed.


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## JPINFV (Aug 21, 2011)

medic417 said:


> :rofl:
> Failure to look is failure to properly evaluate.  You can not accurately advocate for your patient if you do not actually have any true clue as to amount of bleeding.  Clothes absorb much more than you realize before it shows.  Plus many with history of bleeding will use absorbent pads so you may say no blood noticed but they may have a full pad.



Since you almost always will be unable to visualize the site of bleeding, all you will get is a volume of stool mixed with blood.


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## Martyn (Aug 21, 2011)

OK, so let me get this right, you get on scene to a rectal bleed and just load and go, yes? Did anyone take vitals? Anyone ask how long this has been going on? etc etc etc

You get on scene, do your SAMPLE/OPQRST and take vitals. Narrow pulse pressure or normal? Does the PT exhibit signs of shock? Cool, pale diaphoretic etc? Treat for shock!!! Yes, unfortunately it may be necessary to look down below, it may be necessary to apply clean dressings. How long has the bleeding been going on? Has the PT changed dressings? Where are the soiled dressings? It may be necessary to bag them and take with so ER can gauge amount of blood lost. Rectal bleeding should not be treated any differently (ie ain't looking there lets just load and go) to other types of bleeding internal or external.


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## Tigger (Aug 21, 2011)

I think estimations of blood loss in the field beyond "a lot" or "not a lot" based purely on the pool/puddle/stain aren't going to be very accurate. Your vitals are going to tell you whether the patient is shocky, not the relative size of the puddle on the floor (within reason).


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