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🌱來自: checklist

Gastrointestinal bleeding checklist

All inpatients

• NPO
• ABCDE survey
• Consider continuous cardiac monitoring.
• IV fluid resuscitation as needed
• Transfuse pRBCs if Hb ≤ 7-8 g/dL (≤ 9 g/dL for unstable or high-risk patients).
• Obtain routine laboratory studies (e.g., CBC, coagulation panel, blood type and crossmatch, liver chemistries).
• Conduct pre-endoscopy risk stratification to determine diagnostic and therapeutic approach.
• Consider withholding antithrombotic agents as needed.
• Consider anticoagulant reversal.
• Consult specialist(s) for source control: e.g., gastroenterology, general surgery, interventional radiology.
• Evaluate and treat the underlying condition.
• Clinical monitoring, serial CBC and coagulation panel
• Admit to ward or critical care unit based on pre- and post-endoscopy risk stratification (See “High-risk features of GI bleeding”)

Suspected UGIB

• consider intubation if risk of airway compromise.
• start empiric pharmacological treatment if indicated.
• PPI infusion for suspected PUD
• octreotide for suspected esophageal variceal bleeding
• Refer for EGD and endoscopic hemostasis.
• Patient unstable despite resuscitation: Consider angioembolization or surgery.
• See “Glasgow-Blatchford score” to help guide disposition.

Suspected LGIB

• Stable patients: Refer for colonoscopy
• Perform EGD first for unstable patients with hematochezia and any of the following:
• High PTP of UGIB
• Moderate PTP of UGIB with positive or inconclusive NG aspirate
• Consider colonoscopy first for unstable patients with hematochezia and all of the following:
• Moderate PTP of UGIB and negative NG aspirate
• Able to tolerate rapid bowel prep
• Consider angiography for patients with refractory hemodynamic instability
• Consider surgery if other options have failed