5. Abdominal bleeding
Bleeding that starts in the stomach, esophagus, small bowel or colon
Symptoms: An unexplained drop in blood pressure and rise in heart rate can signal internal bleeding, as can weakness, light-headedness and shortness of breath. Symptoms can include vomiting and bloody or dark, tarry stools. Blood spilling into the lining of the abdominal cavity can cause pain, and the stomach will feel rigid.
Confused with: Internal bleeding is notoriously hard to diagnose in the ICU because many patients are already weak and light-headed, and blood pressure and heart rate fluctuations are symptoms of a number of conditions.
Diagnostic tests: Blood tests may show a low red blood cell count or anemia. A stool sample can also detect the bleeding. Endoscopy, angiography and CT and nuclear medicine scans can all help doctors pinpoint the source of the bleeding. If the patient already has a stomach tube in place, medical staff can take a sample of fluids in the stomach.
Treatment: Doctors may put a clip on a bleeding blood vessel or use heat, electric current or laser to stop the bleeding. Surgery is sometimes necessary.
What can you do?
Because critically ill patients often can't communicate very well, family members can be crucial to helping doctors solve the diagnostic puzzle.
First, be sure you know the medical history of your loved one. Older patients, especially, may not be able to list their medications or recall their own medical history — let alone their family's. Doctors may "roll their eyes" when family member comes in with a sheaf of papers or a brown bag stuffed with their loved one's meds, says Winters, but when faced with a difficult diagnosis, any and all information can be "incredibly valuable."
Second, says Newman-Toker, have your "story" ready. Once at the hospital, patients and their families are asked repeatedly to explain what happened. Never assume that the emergency room nurse, say, has conveyed all the right details to the doctor in the ICU. Keep a good track of the problem, including when symptoms developed and what's been done since you arrived at the hospital.
Third, be sure to ask the doctor questions, with the goal of figuring out "whether the doctor is thinking clearly or not," says Newman-Toker. While most laypeople don't have the medical expertise to second-guess the doctor, "they can gauge the extent [to which] the doctor is being curious, meticulous and thoughtful."
Finally, if your gut is telling you something is wrong, "push the doctors to keep looking," Winters says. When family members advocate for their loved ones, physicians are more likely to push beyond their foregone conclusions to get the diagnosis right.
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