Medical Management of Gastrointestinal Hemorrhage
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First Things First (assess for & treat the following)
- Upper GI bleed (UGIB), proximal to ligament of Treitz (LT); lower GI bleed (LGIB), distal to LT
- Airway protection
- Consider endotracheal intubation in a pt w/ massive UGI bleeding, especially if he/she has altered mental status; massive bleeds are more commonly seen in variceal bleeding.
- Circulation
- Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
- Hypotension is a late finding in shock. Never underestimate the magnitude of the GI blood loss.
- Establish two large-bore peripheral lines, or central access if unable to obtain adequate peripheral access.
- Resuscitate using crystalloids, blood and its components with correction of coagulopathy.
- Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
-- To view the remaining sections of this topic, please log in or purchase a subscription --
First Things First (assess for & treat the following)
- Upper GI bleed (UGIB), proximal to ligament of Treitz (LT); lower GI bleed (LGIB), distal to LT
- Airway protection
- Consider endotracheal intubation in a pt w/ massive UGI bleeding, especially if he/she has altered mental status; massive bleeds are more commonly seen in variceal bleeding.
- Circulation
- Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
- Hypotension is a late finding in shock. Never underestimate the magnitude of the GI blood loss.
- Establish two large-bore peripheral lines, or central access if unable to obtain adequate peripheral access.
- Resuscitate using crystalloids, blood and its components with correction of coagulopathy.
- Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
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