Take Home Points
- Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate
- Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers.
- Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well.
- Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity.
LITFL: EBM Upper GI Haemorrhage
EMCrit: Episode 5: Upper GI Bleed Guidelines
EMCrit: Intubating the Critical GI Bleeder
The NNT: Prophylactic Antibiotics for Cirrhotics with Upper GI Bleed
The NNT: Somatostatin Analogues (Octreotide) for Acute Variceal Bleeding
EMRAP HD: Placement of a Blakemore Tube for Bleeding Varices