HYHO UGIB

Question 1

Why should you not use CBC to rule out UGIB?

Answer 1

initial CBC will not be reflective in acute blood loss due to hemo-concentration of remaining circulating volume

Question 2

What’s the first move with an acute UGIB?

Answer 2

insert two large bore IV access

have each one providing different fluids (blood products, .9% NaCl)

*LR should be avoided when transfusions w blood products is considered

Question 3

When is surgical intervention indicated for UGIB?

Answer 3

when endoscopic and TIPS is not indicated or available

Question 4

What medications are given for known or suspected variceal bleeds and/or cirrhosis?

Answer 4

• prophylactic antibiotics: 1g ceftriaxone or a fluoroquinolone 400mg BID
• octreotide (somatostatin) 50mcg IV bolus and then drip at 50mcg/hr

Question 5

When do you give PRBCs?

Answer 5

Acute hemorrhage with hemodynamic instability (hemorrhagic shock)
Acute anemia with inadequate oxygen delivery

Hemoglobin concentration < 7 g/dL (or < 9 g/dL in high risk patients)

Question 6

When do you use FFP?

Answer 6

to correct coagulation deficiency

factor V and factor VII are available for up to 24 hours after thawing

Question 7

What is found in cryoprecipitate?

Answer 7

von Willebrand factor, factor VIII, factor XIII and fibrinogen

Question 8

What is used to tx AI and immunodeficiency states?

Answer 8

immunoglobulins

Question 9

What are platelets used to tx?

Answer 9

stop active bleeding

prevent spontaneous bleeding (incases of thrombocytopenia)

Question 10

What are the five models with a UGIB?

Answer 10

OMT should reserved for after bleeding is under controle, and pt is stable