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<< Gastrointestinal Bleeding: An Evidence-Based ED Approach To Risk Stratification

Key Points In The Management Of Patients With GI Bleeding

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Key Points In The Management Of Patients With GI Bleeding

Key Points In The Management Of Patients With GI Bleeding

  • Involve an endoscopist early in the management of a patient with GI bleeding.
  • If a patient is at risk for bleeding to death, promptly notify both a gastroenterologist and a surgeon, as the patient may need a surgical resection of the bleeding area to stop the bleeding.
  • Promptly consult a vascular surgeon if a patient who has had a prior abdominal aortic aneurysm repair presents with hematochezia. The patient may be harboring a deadly aortoenteric fistula. Surgical repair must take place before the bleeding becomes brisk if the patient is to have a good chance of survival.
  • Recommend discontinuing drugs that can increase the risk of GI bleeding, such as NSAIDs.
  • Initiate proton pump inhibitor treatment in those very lowrisk patients who are discharged from the ED without undergoing endoscopy.
  • There is a high mortality associated with GI bleeding in patients with a history of alcoholism and cirrhotic liver disease.
  • Promptly administer somatostatin when a patient with suspected variceal bleeding (e.g., a history of cirrhotic liver disease, alcoholism, or known varices) presents to the ED.
Publication Information
Authors

John L. Westhoff; Kurtis R. Holt

Publication Date

March 1, 2004

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