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See Upper Gastrointestinal bleed. Arrange endoscopy Immediately if haemodynamically unstable or severe bleed. All others ideally within 24 hours. Note that all ongoing bleeding in a deteriorating patient that has failed reasonable medical or endoscopic therapy becomes a surgical issue

Initial Management of Shock and Haematemesis/Melaena

Give Oxygen 60% unless COPD. Ask Nurses to Get help. Nil by mouth
Get IV access x 2 and start IV fluids Crystalloid (Colloid with Liver disease)
Send bloods including 4-6 cross match if bleeding.
Immediately Reverse anticoagulants/coagulaopathy
If exsanguinating call lab ask for and give O negative blood
Keep NBM. Assess need for urgent Endoscopy Blatchford score
If chronic liver disease/jaundice/spider naevi consider varices as cause
Variceal bleed : OGD + Terlipressin 2 mg stat IV and antibiotic
Non variceal bleed: OGD + IV Omeprazole or equivalent

Initial Management of Shock and Haematemesis/Melaena
Give Oxygen 60% unless COPD. Ask Nurses to Get help. Nil by mouth Get IV access x 2 and start IV fluids Crystalloid (Colloid with Liver disease) Send bloods including 4-6 cross match if bleeding. Immediately Reverse anticoagulants/coagulaopathy If exsanguinating call lab ask for and give O negative blood Keep NBM. Assess need for urgent Endoscopy Blatchford score If chronic liver disease/jaundice/spider naevi consider varices as cause Variceal bleed : OGD + Terlipressin 2 mg stat IV and antibiotic Non variceal bleed: OGD + IV Omeprazole or equivalent

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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