Upper or Lower Gastrointestinal Bleeding admission

The patient could present with passing frank red blood in the stools, vomit blood, or come with severe weakness as a result of severe anemia.

EMS:

IV line

IV Fluids

EKG

Oxygen

Upper GI Bleeding:

ER:

Routine labs

2 Large bore IV lines

IV Fluids

NG Tube aspiration

Type and Cross match at least 2 units

FFP and/or Vitamin K if high INR

PRBC Transfusion

PPI IV Bolus (Protonix 80mg IV bolus and then drip 8mg/hr OR PPI IV bid.

If patient is unstable, admit to ICU

Hospitalist:

Telemetry

Bed rest if very weak and dizzy

IV Fluids-NS if blood pressure on low side. If patient is very anemic, avoid too much IV fluids as it can worsen anemia and cause cardiac events.

NPO

PPI IV

H/H every 2-6hrs depending on severity of bleeding

PRBC transfusion if severe anemia. [If patient is a ‘Jehovah’s Witness’ with symptomatic acute or anemia, you can’t give PRBC transfusion. In such cases, you may have to give Folic acid, vitamin B12, Epoetin [Procrit], IV or Iron with vitamin C for better absorption etc to improve Hb.]

Octreotide bolus followed by drip if continuous bleeding from variceal bleeding

Platelet transfusion if low platelets

Hold offending medications-ASA, Plavix, Coumadin, NSAIDS, Newer anticoagulants

GI Evaluation:

EGD

Bleeding scan, if positive–> IR consult for possible embolization or Surgery consult for surgery


Lower GI Bleeding:

Colon preparation and colonoscopy

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