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Management of Emergency Department Patients with Gastrointestinal Hemorrhage

  • Adam B. SchlichtingEmail author
  • Nicholas M. Mohr
Chapter
  • 79 Downloads

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.

Keywords

Gastrointestinal bleeding Gastrointestinal hemorrhage Hematemesis Melena Hematochezia Hemorrhagic shock Acute blood loss anemia Resuscitation Sengstaken–Blakemore tube Minnesota tube 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Department of Internal MedicineUniversity of Iowa HealthcareIowa CityUSA
  2. 2.Department of Emergency Medicine, Department of AnesthesiaUniversity of Iowa Carver College of MedicineIowa CityUSA

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