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Handoff: Patient with Active GI Bleed

Hand off a high-risk patient with an active GI bleed, focusing on transfusion triggers and parameters for urgent consultation.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Dr. Evans in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

Your Patient List for Handoff

Your Objective

You are the day-team resident finishing your shift. You need to call the on-call night resident, Dr. Evans, to hand off a high-risk patient with a recent GI bleed. Use the I-PASS framework to guide your handoff. Your goal is to provide a clear, concise, and complete picture of the patient, with a strong emphasis on the specific "if/then" contingency plans for the night.

Patient: John Smith, 68M

  • MRN: 123456
  • Room: 603
  • Code Status: Full Code
  • Allergies: Penicillin (rash)
  • Problem List: Lower GI Bleed, Atrial Fibrillation, Hypertension

Hospital Course & Data

History: 68M with hx of atrial fibrillation on Eliquis who presented to the ED this morning with two episodes of large-volume bright red blood per rectum (hematochezia).

Pertinent Labs on Admission:

  • Hemoglobin (Hgb): 7.8 g/dL (baseline is 12.0)
  • Vitals: BP 95/60, HR 110

Current Status: He received 2 units of packed red blood cells (pRBCs) in the ED, and his vital signs have stabilized (BP 115/70, HR 85). His Eliquis has been held. He has had no further bleeding in the past 6 hours. GI was consulted; they performed an EGD which was negative, and they plan for a colonoscopy in the morning.

Most Recent Labs (post-transfusion):

  • Hemoglobin (Hgb): 9.2 g/dL

Overnight Plan & Watch-Outs

The main task for tonight is to monitor for re-bleeding and hemodynamic instability.

Key Tasks for Night Team:
  1. Continue to hold Eliquis.
  2. Serial vital sign checks every 4 hours.
  3. Check a repeat Hemoglobin (Hgb) at 4 AM.
Anticipatory Guidance: The biggest risk is another bleed. Be very clear about the parameters for action.
  • If/Then for Transfusion: If the 4 AM Hgb is <7 g/dL OR if he becomes hypotensive again, transfuse one unit of pRBCs.
  • If/Then for GI Consult: If he has another large-volume bleed or becomes unstable requiring more than one unit of blood, call the GI fellow on call immediately.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Apply the I-PASS framework to structure a verbal handoff for a high-acuity patient.
  • Formulate clear anticipatory guidance, including specific triggers for transfusion and urgent consultation for a patient with an active GI bleed.
  • Synthesize complex patient data to prioritize and communicate the most critical information for overnight care.

For a hemodynamically stable patient with an active upper GI bleed and no significant cardiac comorbidities, what is the generally recommended hemoglobin threshold for transfusing packed red blood cells (pRBCs)?

Which of the following clinical changes would be the MOST critical trigger to include in your 'if/then' plan for an urgent Gastroenterology (GI) consultation overnight?