EM Fundamentals

APPROACH TO GI BLEEDING

Goals and Objectives Goals Resident will be comfortable with initial evaluation and basic management of patients with GI bleeding Learning Objectives Resident will be able to: List common etiologies of upper and lower GI bleeds Define and recognize: hematemesis, coffee-ground emesis, melena, hematochezia and BRBPR List acute interventions indicated for all patients with GI bleeding List potential medical interventions for GI bleeding and their indications Blood products Anticoagulant reversal agents PPIs Somatostatin analogs Antibiotics Describe indications for admission, transfusion, urgent vs emergent GI consultation, and surgical consultation for patients with GI bleeding Explain the concept of massive transfusion protocols and indications for use

Recommended Resources Prior to Conference Massive GI Bleed (EM:RAP C3, start at 2:10) Upper GI Bleeding in the ED (EBMedicine) Additional Resources Approach/Review Upper GI Bleeding in the ED (EBMedicine) Acute Lower GI Bleeding: ACG Clinical Guideline (AM J Gastro 2016) Upper Gastrointestinal Bleeding: Evidence-Based Treatment (ALIEM) Approach to GI Bleeding (CDEM) Massive GI Bleeding (CDEM) PV Card: Upper GI Bleed (ALIEM) Upper GI Bleeding Guidelines (Practical Evidence) Bleeding PUD (NEJM 2008) (pdf) Procedures Intubating the Critical GI Bleeder (EMCrit) Blakemore Placement (EMCrit) NG Lavage: Indicated or Outdated? (ALIEM)

Original Post by Eric Shappell on 11/03/2014
Last Updated by Eric Shappell on 06/12/2016 Contact / Feedback