Acute GI Bleed Pearls

(Gastrointest Endosc 2004;60:497-504)

PRE-ENDOSCOPY

Questions to ask:

Nature and duration of bleed: When did it start? First time/Recurrent?

Symptoms: Fever, Pain, Dyspepsia, Hematemesis/Coffee grounds, Hematachezia/Melena/BRBPR, Clots

History: Past bleeds, Trauma, Surgery, Liver disease, Renal disease

Medications: NSAIDs, Coumadin, Antiplatelets

Physical Exam: Vital Signs! CV exam, Abdominal/Rectal exams

Labs: CBC/Chemistries, PT/INR, PTT, Type & Cross, EKG (if age >50 or CAD risk factors)

IV access: Fluids, Blood

NG tube needed?

Sclerosing agent needed at bedside? (i.e. liver patient)

Endoscopy Therapy Contraindications:

Risk > Benefit

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