4-25 EM IM JOINT CONFERENCE

APPROCH TO UPPER GASTROINTESTINAL BLEEDING

Key Learning Points

 As a general rule, presented with an ER case, primary survey is to check for

o Airway
o Breathing
o Circulation
o Disability
o Exposure
 After Checking for the primary survey and verified that we can proceed, the secondary
survey ensues.

 Patient presented with UGIB and according to the Algorithm of Rosen’s emergency
medicine, 10th edition, there are things that we must consider.
o If the patient is unstable (through deranged VS and PE)
 Resuscitation must come first through giving of fluids
o If the patient then is or becomes stable,
 We now must identify the possible sources of bleeding through
 Thorough / Re History
 Thorough/ Redo of PE
 Ancillary testing (imaging, and blood workups)

 The location then of the bleeding is then further categorized to UPPER GI BLEED (source is
from Oral Mucosa to the duodenum) OR LOWER GI BLEED (source is from cecum to anus),
then further categorized to risks

 If it is from UPPER GI
o High Risk:
 Continuous bleeding
 Hemodynamically unstable
 Suspicious Hx
 Px will then be managed accordingly
 Stabilization via resuscitation and intubation as needed
 Then Visualization via endoscopy
 ICU admission
o Indeterminate Risk
 Stable vital signs and no aggressive bleeding
 May be discharged or admitted in the wards via Blatchford scoring
 If it is from Lower GI bleed
o High Risk: Brisk bright red bleeding. Hemodynamically unstable
 If CTA localizes bleeding  prompt IR management
 If CTA does not localize bleeding  Prompt surgical management

o Indeterminate risk:
 If bleeding source is seen, stable VS, no comorbids, age <60
 Discharge and ffup
 If Not
 Admit and urgent GI colonoscopy.