[Gastrointestinal bleeding with development of shock in an island environment--case report and review of literature].

The life-threatening gastrointestinal (GI) bleeding is most common in the elderly burdened with considerable comorbidity. Vital sign observation is of greatest significance to estimate the severity of bleeding. The management of hemorrhagic shock has to be directed to rapid compensation and stopping of further loss of the intravascular volume in order to normalize blood pressure and establish appropriate organ perfusion. The basis of initial resuscitation is the administration of a sufficient amount of crystalloids or colloids. Blood transfusion should be used in patients showing the signs of shock when crystalloid infusion is > 50 ml/kg. Uncrossmatched, type specific blood is usually available and can be safely administered in hospitals within 15-20 minutes of the request receipt. If type specific blood is not available, 0-negative packed red blood cells are used. When 0-negative packed blood cells are not available, 0-positive oacked cells may be used except in female patients of reproductive age. When hemodynamic stabilization has been achieved, endoscopic examination should be done to localize the bleeding and institute hemostasis, if necessary. A case is presented of a 78-year-old woman with severe GI bleeding, multiple comorbidity, and development of shock. The bleeding was possibly provoked by the use of nonsteroidal anti-inflammatory drugs. The objective of this report is to present the possibilities available at the Korcula Medical Center in treating patients with upper GI bleeding. The main purpose to joint to the necessary upgrading of health service in outpatient conditions, and especially to the need of maintenance and development of specialist services on Croatian islands.islands in order to improve the safety of living for the islanders as well as for the growing tourist population who spend their holidays on Croatian islands.