Approach to acute upper gastrointestinal bleeding in adults - UpToDate

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  • crossmatch for hemodynamic instability, severe bleeding, or high-risk patient

  • hemoglobin concentration (note that measurement may be inaccurate with acute severe hemorrhage), platelet count, coagulation studies (prothrombin time with INR), liver enzymes (AST, ALT), albumin, BUN, and creatinine

  • Evidence of active bleeding (eg, hematemesis, hemodynamic instability), give esomeprazole or pantoprazole, 80 mg IV

  • Endoscopy delayed beyond 12 hours, give second dose of esomeprazole or pantoprazole, 40 mg IV

  • Give somatostatin or an analogue (eg, octreotide 50 mcg IV bolus followed by 50 mcg/hour continuous IV infusion)

  • Give an IV antibiotic (eg, ceftriaxone or fluoroquinolone)

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