Establish two large bore IV lines (16 gauge or larger) |
Provide supplemental oxygen (goal oxygen saturation ≥94% for patients without COPD)
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Treat hypotension initially with rapid, bolus infusions of Normal Saline(eg, 500 to 1000 mL per bolus; use smaller boluses and lower total volumes for patients with compromised cardiac function)
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Transfusion: |
For severe, ongoing bleeding, immediately transfuse blood products in 1:1:1 ration of RBCs, plasma, and platelets, as for trauma patients |
For hemodynamic instability despite crystalloid resuscitation, transfuse 1 to 2 units RBCs |
For hemoglobin <8 g/dL (80 g/L) in high-risk patients (eg, older adult, coronary artery disease), transfuse 1 unit RBCs and reassess the patient's clinical condition |
For hemoglobin <7 g/dL (70 g/L) in low-risk patients, transfuse 1 units RBCs and reassess the patient's clinical condition |
Avoid over-transfusion with possible variceal bleeding |
Give plasma for coagulopathy or after transfusing four units of RBCs; give platelets for thrombocytopenia (platelets <50,000) or platelet dysfunction (eg, chronic aspirin therapy) or after transfusing four units of RBCs
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Obtain immediate consultation with gastroenterologist; obtain surgical and interventional radiology consultation for any large-scale bleeding¶
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Pharmacotherapy for all patients with suspected or known severe bleeding: |
Give a proton pump inhibitor: |
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Pharmacotherapy for known or suspected esophagogastric variceal bleeding and/or cirrhosis: |
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Give an IV antibiotic (eg, ceftriaxone or fluoroquinolone) |