Managing Upper GI Bleeds

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