Acute Upper GI Bleed
ABC. Protect airway and keep NBM. Insert 2 large bore
Bloods: FBC, U+E, glucose, clotting, cross-match 6 units
(or G+S), LFTs
High flow oxygen
Rapid IV colloid infusion
If remains shocked give blood. Correct clotting
Set up CVP line to guide fluid replacement. Catheterize.
Urgent endoscopy for diagnosis and control of bleeding
(<4h for variceal, 12-24h for other)
Varices: banding, sclerotherapy. If bleeding continues
pass Sengstaken-Blakemore tube. Avoid hepatic encephalopathy.
Peptic ulcer (40%) > MV tear (15%) > GD erosions (10%)
Haematemesis, melaena, dizziness, abdominal pain, dysphagia, postural
hypotension/hypotension, tachycardia, telangiectasia or purpura,