GI Bleeding
GI Bleeding
Stable Vital Signs
Hemoglobin > 6.0
If they are on full dose anticoagulation (Warfarin, DOAC/NOAC, Lovenox) GI must be ok with scope in next 24 hours.
Suspected Diverticular bleeding, or bleeding due to esophagitis/gastritis
If presentation of Melena, has not recurred in ED
Hematemesis not recurrent in ED
Small to moderate volume BRBPR or Maroon Stool OK
Platelets > 100
No recent admissions for similar symptoms with negative workups
Ambulatory
History of Chronic Liver disease, Varices, Portal Hypertension
On Dual Anti-Platelet Therapy
Recurrent Melena or Hematemsis in ED
Recent syncope
Need period of washout of anti-coagulant (>24 hrs)
Cardiac Monitor
Maintaine Active T&S
Ensure two points of IV access, preferably large bore
Serial H/H Q6 hr
If drop of 1 point of Hb or more over two consecutive measurements, admit
Transfuse PRBC to goal of 7.0
Consult GI for endoscopy
NPO @ midnight
If upper source suspected, IV PPI BID
Disposition
Stable or uptrending H/H over two serial measurements
No recurrent episodes of GI bleeding
Normal, stable vital signs
Cleared by GI
Ambulatory, Safe Discharge destination
Ongoing drop in H/H or Ongoing apparent GI bleeding
Tachycardia, Hypotension
Crticial findings on Endoscopy
Need for further investigations into source of bleeding (CTA, Tagged Red scan, capsule study etc)
Need for > 1 unit of PRBC