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Management of Emergency Department Patients with Gastrointestinal Hemorrhage

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Emergency Department Critical Care

Abstract

Gastrointestinal (GI) hemorrhage is a common complaint of patients presented to the emergency department, and most episodes of GI bleeding resolve spontaneously. In select cases, however, patients require aggressive resuscitation and rapid implementation of definitive care. Much of the literature discussing management of acute GI bleeding focuses on determining the source of bleeding, however, we attempt to take a more pragmatic approach and focus on resuscitating patients while simultaneously obtaining evidence to localize bleeding. This chapter will explain the key aspects of resuscitation specific to an unstable patient with GI hemorrhage and hemorrhagic shock. We present the evidence supporting adequate intravenous access, transfusion of blood products, and pharmacotherapy. Definitive interventions including endoscopy and interventional radiology will be discussed, but as these techniques are often performed after hospital admission, we will focus on temporizing measures to improve survival while definitive therapy is arranged. Detailed procedures regarding insertion of a balloon tamponade device (commonly referred to as a Minnesota tube or a Sengstaken–Blakemore tube) will be discussed.

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Authors and Affiliations

  1. Department of Emergency Medicine, Department of Internal Medicine, University of Iowa Healthcare, Iowa City, IA, USA

    Adam B. Schlichting

  2. Department of Emergency Medicine, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Nicholas M. Mohr

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  1. Adam B. Schlichting
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Correspondence to Adam B. Schlichting .

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  1. College of Medicine, University of Florida Health Science Center, Jacksonville, FL, USA

    Joseph R. Shiber

  2. Resuscitation & Emergency Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Scott D. Weingart

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Schlichting, A.B., Mohr, N.M. (2020). Management of Emergency Department Patients with Gastrointestinal Hemorrhage. In: Shiber, J., Weingart, S. (eds) Emergency Department Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-28794-8_14

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