Thanks to Dr. Duminda Suraweera for an excellent review of UGIB management

Learning points:
• Triage:
– SDU vs ICU depending on etiology of upper GI bleed, BP, HR, mental status, ability to protect airway and continued active bleeding
• Immediate interventions:
– Resuscitate, resuscitate AND resuscitate with IVFs
– Transfuse pRBCs to keep Hg>7 as per guidelines published in NEJM
– Transfuse FFP and give vitamin K to reverse coagulopathy and maintain INR<1.5
– Transfuse platelets to keep levels >50K
– Start PPI gtt vs intermittent PPI therapy to promote platelet aggregation and clot formation
– Start Octreotide gtt to decrease portal hypertension via vasoconstriction of splanchnic circulation
– Start short course of Ceftriaxone or Norfloxacin in cirrhotic patients with UGIB in an effort to decrease risk of SBP

Click on this great review article for more learning on variceal hemorrhage