Assessment & Plan (short)
# Upper GI Bleed
Patient presents with new melena/coffee ground emesis concerning for upper GI Bleed. History notable for ***. DDx includes gastric and/or duodenal ulcers, esophagitis, gastritis/duodenitis, Mallory-Weiss syndrome, angiodysplasia, malignancy, and Dieulafoy's lesion. Disposition per Glasgow Blatchford score ***.
Dx
- CBC, CMP, INR, Type and screen, H pylori Ag
- Telemetry
- GI consult/Endoscopic evaluation per clinical scenario
Tx
- Protonix 80mg bolus x1, followed by Protonix 40 mg IV BID
- If concerned for variceal bleed in cirrhotic, consider Octreotide and Ceftriaxone
- NPO
- 2 large bore IVs
- Transfuse to keep hgb >7
- Hold antiplatelet agent, anticoagulation, anti-hypertensives
- Correct coagulopathy (Goal plt > 50k, INR < 2.0)
Organ systems
Medical field
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Author
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Originally created: March 3, 2020 by Eric Lee
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