REMSTARBC.ca    Rural Emergency Medicine Simulation Training and Resource - British Columbia

Below is a Power Point on the management of Upper GI bleeds.

Summary of Managing Upper GI Bleeds

  1. ABCDE
  2. Labs – CBC, Na, K, Ca, Mg, troponin, BUN, Creat, ECG, CXR, INR, Type X-M.
  3. Normal Saline
  4. NG tube IF clearing stomach for Intubation or endoscopy, OR if trying to determine if bleeding is upper or lower site.
  5. Transfuse if Hg < 90 in high risk (CAD, elderly) Hg < 70 in low risk
  6. Pantoprazole 40 mg IV
  7. If Variceal bleed or Cirrhosis
    Octreotide 50 mcg IV bolus then 50 mcg/hr infusion
    Ceftriaxone 2 gm IV

 If need for Intubation:

  1.  Eye protection
  2. Place NG tube
  3. Metoclopramide 10 mg IV
  4. Elevate head of bed 30-45 degrees
  5. Pre-oxygenate with mask at 15 L/m x 3 minutes
  6. RSI checklist
  7. Ketamine 1 - 2mg/Kg
  8. Rocuronium 1.2 mg/Kg
  9. Have push dose pressor ready