What Is the Optimal Resuscitation of the Patient with a Gastrointestinal Bleed?

  • Kathleen Ogle
  • Andrew C. MeltzerEmail author


Hemodynamic resuscitation is a critical component of early management for patients presenting with GI bleeding. Resuscitation includes intravenous crystalloid fluid or blood products. Unstable patients require multiple blood products, and protocols established in trauma literature for massive transfusion can be applied for patients with severe GI bleeds.


Gastrointestinal hemorrhage Risk stratification Early management Restrictive versus liberal transfusion 


  1. 1.
    Oliwa N, Mort TC. Is a rapid sequence intubation always indicated for emergency airway management of the upper GI bleeding patient? Crit Care Med. 2005;33:A97.CrossRefGoogle Scholar
  2. 2.
    Strote J, Mayo M, Townes D. ED patient estimation of blood loss. Am J Emerg Med. 2009;27(6):709–11.CrossRefGoogle Scholar
  3. 3.
    Rubin M, Hussain SA, Shalomov A, Cortes RA, Smith MS, Kim SH. Live view video capsule endoscopy enables risk stratification of patients with acute upper GI bleeding in the emergency room: a pilot study. Dig Dis Sci. 2011;56(3):786–91.CrossRefGoogle Scholar
  4. 4.
    Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. 1999;340(6):409–17.CrossRefGoogle Scholar
  5. 5.
    Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11–21.CrossRefGoogle Scholar
  6. 6.
    Weingart S. EMCrit Podcast 5 – Intubating the Critical GI Bleeder. EMCrit Blog. Published on June 21, 2009. Accessed on 10 May 2018. Available at:
  7. 7.
    McGee S, et al. The rational clinical examination. Is this patient hypovolemic. JAMA. 1999;281(11):1022–9.CrossRefGoogle Scholar
  8. 8.
    DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. West J Emerg Med. 2017;18(1):117–20. Scholar
  9. 9.
    Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–13.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineGeorge Washington University School of Medicine & Health SciencesWashington, DCUSA

Personalised recommendations