Template:Upper GI bleed treatment - Revision history

Danbot: Add AntibioticDose entries: Erythromycin

2026-03-20T10:54:35Z

Add AntibioticDose entries: Erythromycin

← Older revision		Revision as of 10:54, 20 March 2026
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	**May require pressors and fluids		**May require pressors and fluids
	**Consider withholding early antibiotics, but doing the rest of the sepsis treatments		**Consider withholding early antibiotics, but doing the rest of the sepsis treatments
			*{{AntibioticDose\|drug=Erythromycin\|dose=3mg/kg IV over 20-30min, 30-90min prior to endoscopy; Achieves endoscopy conditions equal to lavage<ref>Pateron D, et al. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann Emerg Med. 2011; 57(6):582-589.</ref>\|context=Pre-endoscopy\|disease=Undifferentiated upper gastrointestinal bleeding\|population=Adult}}

Rossdonaldson1: /* Other Interventions */

2024-06-19T19:09:05Z

Other Interventions

← Older revision		Revision as of 19:09, 19 June 2024
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	===Other Interventions===		===Other Interventions===
	====[[Balloon tamponade]] ~~with~~ Sengstaken-Blakemore ~~Tube~~====		====[[Balloon tamponade]] (e.g., Sengstaken-Blakemore or Minnesota Tubes)====
	''For life-threatening hemorrhage if endoscopy is not available''		''For life-threatening hemorrhage if endoscopy is not available''
	*Adverse reactions are frequent:		*Adverse reactions are frequent:

Rossdonaldson1 at 20:52, 7 February 2024

2024-02-07T20:52:35Z

← Older revision		Revision as of 20:52, 7 February 2024
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	*Monitor for [[hypocalcemia]]		*Monitor for [[hypocalcemia]]

	===[[Balloon tamponade]] with Sengstaken-Blakemore Tube===		===Other Interventions===
			====[[Balloon tamponade]] with Sengstaken-Blakemore Tube====
	''For life-threatening hemorrhage if endoscopy is not available''		''For life-threatening hemorrhage if endoscopy is not available''
	*Adverse reactions are frequent:		*Adverse reactions are frequent:
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	**Tracheal compression (consider intubation prior to balloon insertion)		**Tracheal compression (consider intubation prior to balloon insertion)

	===Endoscopy===		====Endoscopy====
	''Should be performed at the discretion of the gastroenterologist; within 12 hrs for variceal bleeding<ref>Kim YD. Management of acute variceal bleeding. Clin Endosc. 2014; 47(4):308–314.</ref>''		''Should be performed at the discretion of the gastroenterologist; within 12 hrs for variceal bleeding<ref>Kim YD. Management of acute variceal bleeding. Clin Endosc. 2014; 47(4):308–314.</ref>''
	*Early endoscopy does not necessarily improve clinical outcomes<ref>Sarin N et al. Time to endoscopy and out- comes in upper gastrointestinal bleeding. Can J Gastroenterol. 2009;23(7):489-493. </ref>		*Early endoscopy does not necessarily improve clinical outcomes<ref>Sarin N et al. Time to endoscopy and out- comes in upper gastrointestinal bleeding. Can J Gastroenterol. 2009;23(7):489-493. </ref>
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	**Achieves endoscopy conditions equal to lavage<ref>Pateron D, et al. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann Emerg Med. 2011; 57(6):582-589.</ref>		**Achieves endoscopy conditions equal to lavage<ref>Pateron D, et al. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann Emerg Med. 2011; 57(6):582-589.</ref>

	===[[Intubation]]===		====[[Intubation]]====
	''Protection of airway from massive aspiration, especially prior to endoscopy; does not protect against pneumonia or cardiopulmonary events<ref>Rudolph SJ et al. Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc. 2003 Jan;57(1):58-61.</ref>''		''Protection of airway from massive aspiration, especially prior to endoscopy; does not protect against pneumonia or cardiopulmonary events<ref>Rudolph SJ et al. Endotracheal intubation for airway protection during endoscopy for severe upper GI hemorrhage. Gastrointest Endosc. 2003 Jan;57(1):58-61.</ref>''
	;NO CHRISTMAS<ref>Weingart S. EMCrit Podcast 5 – Intubating the Critical GI Bleeder. June 2009. http://emcrit.org/podcasts/intubating-gi-bleeds/</ref>		;NO CHRISTMAS<ref>Weingart S. EMCrit Podcast 5 – Intubating the Critical GI Bleeder. June 2009. http://emcrit.org/podcasts/intubating-gi-bleeds/</ref>

Elcatracho: /* Resuscitation */

2021-03-01T20:16:05Z

Resuscitation

← Older revision		Revision as of 20:16, 1 March 2021
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	===Resuscitation===		===Resuscitation===
	*Place 2 large bore IVs (or [[sheath introducer]]) and monitor airway status		*Place 2 large bore IVs (or [[sheath introducer]]/[[rapid infusion catheter]]) and monitor airway status
	*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and ~~dilatational~~ coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)		*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)

	===Medications===		===Medications===

Elcatracho: /* Intubation */

2021-02-21T03:10:49Z

Intubation

← Older revision		Revision as of 03:10, 21 February 2021
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	;NO CHRISTMAS<ref>Weingart S. EMCrit Podcast 5 – Intubating the Critical GI Bleeder. June 2009. http://emcrit.org/podcasts/intubating-gi-bleeds/</ref>		;NO CHRISTMAS<ref>Weingart S. EMCrit Podcast 5 – Intubating the Critical GI Bleeder. June 2009. http://emcrit.org/podcasts/intubating-gi-bleeds/</ref>
	''Have bed-side [[Push-dose pressors\|push-dose pressors]] on hand''		''Have bed-side [[Push-dose pressors\|push-dose pressors]] on hand''
	*'''N'''GT (salem sump to remove stomach contents)		*'''N'''GT ([[Nasogastric tube placement\|salem sump]] to remove stomach contents)
	**Varices not contraindication to NGT		**Varices not contraindication to NGT
	**Consider [[metoclopramide]] 10mg IV		**Consider [[metoclopramide]] 10mg IV

Elcatracho: /* Resuscitation */

2021-01-21T09:26:12Z

Resuscitation

← Older revision		Revision as of 09:26, 21 January 2021
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	===Resuscitation===		===Resuscitation===
	*Place 2 large bore IVs (or [[sheath introducer]])and monitor airway status		*Place 2 large bore IVs (or [[sheath introducer]]) and monitor airway status
	*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)		*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)

Elcatracho: /* Resuscitation */

2021-01-21T02:42:36Z

Resuscitation

← Older revision		Revision as of 02:42, 21 January 2021
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	===Resuscitation===		===Resuscitation===
	*Place 2 large bore IVs (or [[sheath introducer~~/cordis~~]])and monitor airway status		*Place 2 large bore IVs (or [[sheath introducer]])and monitor airway status
	*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)		*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)

Elcatracho: /* Resuscitation */

2021-01-21T02:36:36Z

Resuscitation

← Older revision		Revision as of 02:36, 21 January 2021
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	===Resuscitation===		===Resuscitation===
	*Place 2 large bore IVs and monitor airway status		*Place 2 large bore IVs (or [[sheath introducer/cordis]])and monitor airway status
	*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)		*Crystalloid [[IVF]] can be used for initial resuscitation but should be limited due to the dilutional anemia and dilatational coagulopathy that can result (i.e. IV fluid use in non-compressible hemorrhage)

Elcatracho: /* Other Blood Products */

2021-01-17T15:03:17Z

Other Blood Products

← Older revision		Revision as of 15:03, 17 January 2021
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	*[[Prothrombin complex concentrates]]<ref>Makris M, et al. Warfarin anticoagulation reversal: management of the asymptomatic and bleeding patient. J Thromb Thrombolysis. 2010; 28:171–181.</ref>		*[[Prothrombin complex concentrates]]<ref>Makris M, et al. Warfarin anticoagulation reversal: management of the asymptomatic and bleeding patient. J Thromb Thrombolysis. 2010; 28:171–181.</ref>
	*[[Cryoprecipitate]] to raise fibrinogen (goal >120mg/dL)		*[[Cryoprecipitate]] to raise fibrinogen (goal >120mg/dL)
	*[[Platelets]] (goal >50-100k/μL		*[[Platelets]] (goal >50-100k/μL)
	*[[FFP]] can be used to correct anticoagulated patients, but is not indicated in cirrhotics with variceal bleeding<ref>Intagliata NM, et al. Management of disordered hemostasis and coagulation in patients with cirrhosis. Clinical Liver Disease. 2014; 3(6):114-117.</ref>		*[[FFP]] can be used to correct anticoagulated patients, but is not indicated in cirrhotics with variceal bleeding<ref>Intagliata NM, et al. Management of disordered hemostasis and coagulation in patients with cirrhosis. Clinical Liver Disease. 2014; 3(6):114-117.</ref>
			*Monitor for [[hypocalcemia]]

	===[[Balloon tamponade]] with Sengstaken-Blakemore Tube===		===[[Balloon tamponade]] with Sengstaken-Blakemore Tube===

Elcatracho: /* Intubation */

2021-01-17T14:55:29Z

Intubation

← Older revision		Revision as of 14:55, 17 January 2021
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	**Varices not contraindication to NGT		**Varices not contraindication to NGT
	**Consider [[metoclopramide]] 10mg IV		**Consider [[metoclopramide]] 10mg IV
			***Increases tone of lower esophageal sphincter<ref>Mikami H, Ishimura N, Fukazawa K, et al. Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers. J Neurogastroenterol Motil. 2016;22(1):112-117. doi:10.5056/jnm15130</ref>
	*Good pre-'''O'''xygenation critical		*Good pre-'''O'''xygenation critical
	*'''C'''hest and '''H'''OB elevation to 45 degrees - consider intubating from 45 degrees to prevent gastric contents coming up		*'''C'''hest and '''H'''OB elevation to 45 degrees - consider intubating from 45 degrees to prevent gastric contents coming up