Prescribing Safety Assessment (PSA) Practice Exam

During management of Gastroenterology Bleeds, what is the recommended action for fluid replacement?

1. Fluid bolus of 250ml

2. Fluid bolus of 500ml

3. Fluid bolus of 1000ml

4. No fluid replacement

The correct answer is: Fluid bolus of 500ml

In the management of gastrointestinal (GI) bleeds, fluid replacement is crucial for maintaining hemodynamic stability and ensuring adequate tissue perfusion. A fluid bolus of 500ml is often considered a practical approach in these scenarios, particularly when rapid resuscitation is needed. A 500ml bolus strikes a balance between providing enough volume to counteract the potential hypovolemia from bleeding, while also allowing for careful monitoring of the patient's response. This volume is often sufficient to achieve a clinically significant improvement in blood pressure and heart rate, indicators of improved perfusion. Smaller boluses, such as 250ml, may not provide enough volume to adequately restore hemodynamics in the face of significant bleeding. On the other hand, a bolus of 1000ml may be excessive in certain cases, especially in patients with heart failure or other comorbidities that may predispose them to fluid overload. Therefore, the recommendation for a 500ml fluid bolus aligns with current guidelines and best practices in the management of GI bleeds, ensuring that patients receive effective initial resuscitation without risking potential complications from excessive fluid administration.