GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 271

required to treat this life-threatening disorder, every effort must be made to get the indi-
vidual to a hospital as quickly as possible.
If,inaremotearea,helicoptertransportcannotbeachievedpromptly,theconditionmust
be managed in the field. Attempting litter evacuation or walking out with assistance while
active bleeding is occurring is unwise. Fortunately, a young person usually stops bleed-
ing within twelve to twenty-four hours. Six to twelve hours after bleeding appears to have
stopped, a choice between remaining in camp at rest for one to three days and attempt-
ing to reach a hospital must be made. A slow pulse, cessation of vomiting, and a normal
brown stool color are indications that relatively little blood has been lost and bleeding has
stopped. However, rebleeding can occur at any time. Careful consideration must be given
to the unique circumstances found in every situation.
Individualsareusuallyveryweakafterasignificantbleedingepisodeandrequireassist-
ance during evacuation. They should by no means attempt to continue vigorous activities,
even if feeling well at rest.
Exceptfortheoccasionalindividualswhobleedslightlyafterprolongedretching,essen-
tially all gastrointestinal bleeding in otherwise healthy young adults is due to peptic ulcer.
However, even though the ulcer is almost always present prior to the hemorrhage, it may
be totally asymptomatic.
The signs and symptoms of serious gastrointestinal bleeding include the following:
Faintness or weakness, which is more prominent when erect than when lying down
Vomiting obvious blood
Vomiting material that looks like coffee grounds (blood that has been partially digested
in the stomach)
Rectal passage of obvious blood
Passage of liquid or solid tarry-black stools (blood that has been digested in the intest-
ines.) (Iron, which is contained in vitamin and mineral preparations, and the bismuth in
Pepto-Bismol® also can cause stools to have a dark color.)
Shock
No medications currently available stop heavy bleeding from peptic ulcers. However,
high-doses of a PPI often significantly reduce the rate of bleeding. H 2 blockers may be
helpful if a PPI such as omeprazole is not available.
When the bleeding ceases, acid-suppressive drugs lessen the likelihood of rebleeding.
Inaddition, smokingmustcease! AspirinandotherNSAIDs,alcohol, andcaffeinemustbe
avoided. The individual should rest as much as possible. If a substantial amount of blood
hasbeenlostandthepersonbecomeslightheadedwhenerect,theindividualshouldbekept
supine. If signs of shock, particularly low blood pressure and rapid heart rate, appear, ap-
propriate treatment should be instituted ( Chapter 3: Life-Threatening Problems ) .
Oncetheindividualhasstabilized,evacuationshouldbecarriedoutintheleastdemand-
ing and least stressful way possible.