In a gastrointestinal bleed the order of your actions is the treatment. Rank each board 1 to 4 and read the rule that decided it — airway, then circulation, then access and products, then notify — and remember that percussion and palpation change what you would have heard. Then switch to the bleed panel and find out why a normal haemoglobin in hour one is the most dangerous number on the chart.
Choose a board
The situation
Rank 1 (do first) to 4 (do last)
Boards checked: 0 · Perfect orders: 0
Load a patient
Enter the panel
Sets the haemoglobin reference
Normal 14–18 men, 12–16 women
Normal 10–20
Normal 0.6–1.2
>2 hypoperfusion · >4 emergency
Normal 0.8–1.1
The two traps in this panel
A normal haemoglobin in the first hours means nothing — whole blood is lost, so the concentration does not fall until plasma is replaced or you give fluid. And the INR does not measure the direct oral anticoagulants at all; a normal INR on apixaban is not a normal coagulation state.
Put the four actions in order
Use each number once, then press Check my order. Every action here is something a nurse would eventually do — the question is only what buys the most time in the next sixty seconds.
The priority ladder used all chapter
Airway and aspiration risk — blood in the airway kills faster than blood in the gut.
Circulation and perfusion — access, isotonic fluid, products.
Acute change over chronic problem, and unstable over stable.
Actual harm over potential harm, and planned teaching last.