Upper GI Bleeds
- Amrit Saini
- Jul 28, 2024
- 2 min read
Definition: bleeding originating from source proximal to ligament of Treitz
Two large bore IVs (ideally 16g or larger bore). Give Crystalloid IVF (lactated ringers) if blood is not available.
Reduces rate of re-bleed if ulcer, but does not change morbidity or mortality (except for Asian patients?)
Give ceftriaxone 1gm/daily or ciprofloxacin 500 BID for any patient with cirrhosis or EtOH abuse
Prophylaxis against SBP. Shown to improve mortality.
Octreotide- 50mcg bolus then 50mcg/hr continuous for anyone with a concern for variceal bleed
GI for endoscopy. If not available, place a blakemore tube. Know that there are common adverse events: tracheal compression (intubate prior to balloon), esophageal/gastric rupture, mucosal ulceration.
When intubating this patient make sure you have push dose pressors. To do this, grab an amp of code cart epinephrine, take 10ml of NS flush and remove 1ml (9mL in the syringe) and place 1 mL of code cart epi into the syringe. MIX WELL.
Place OGT or NGT to remove stomach contents (variceal bleed is not a contraindication). Give reglan 10mg to increase lower esophageal sphincter tone.
Intubate at 45deg if the patient is not vomiting. Iif vomiting, place the patient in trendelenburg position.
Other important facts:
A BUN-to-creatinine ratio greater than 36 in the setting of no renal failure can be highly suggestive of UGIB.
Electrocardiography should be performed in older adults or those with known coronary artery disease who are at higher risk for demand ischemia in the setting of hypotension or anemia due to a GIB.
CORDIS:
used for rapid transfusion with belmont. Video to see placement of cordis. Remember that this is usually done in a crash situation, aka clean the area but no drape, no sterile gloves. This is why we practice landmark based femoral lines! Know flow rates (aka 16g> Cordis> 18g> triple lumen)! We had a 16g in the patient’s arm, which means we can give blood quicker via that
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