Gi Bleeding

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Al Sacchetti, MD  gives a curbside consult on massive GI bleeding.

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ROBERT B. -

Al, what about Blakemore Tubes?

Alfred S. -

Was just focusing on pharmacologic management but since you brought it up. Blakemore tubes still an option, but rarely used since endoscopy so readily available. Outcome data with the device are mixed. But if you are in an area where access to an endoscopist is limited and the pharmacologic management is not working, it is certainly worth a try. In our shop the biggest problem is finding a football helmet to anchor the tube.

ryan harris -

what about TXA?
cheap, purportedly isn't prothrombogenic
here's the link to Pescatore's article in EM news.

https://journals.lww.com/em-news/Fulltext/2018/11000/What_to_D_O___No_Reason_Not_to_Use_TXA_for.3.aspx

Alfred S. -

I can never argue with TXA in any bleeding patient. At present it is not part of the recommendations for variceal bleeding since this bleeding is more of a pressure phenomenon. It does decrease blood usage but does not seem to impact mortality. However, in circumstances where a patient has uncontrollable variceal bleeding, I would certainly give it a try.

Stephen C. -

Should specify he is talking about variceal bleeding not a bleeding ulcer

Alfred S. -

The emphasis is on variceal bleeding, but clinically it may be difficult to determine the source of the upper gi blood. Under those circumstances the is nothing to loose treating a patient as if the bleeding is coming from esophageal varies.

Joel B., M.D. -

The NNT.com says no mortality benefit with octreotide in AVB.

https://www.thennt.com/nnt/octreotide-for-acute-variceal-bleeding/

Alfred S. -

Joel:

The review you cite demonstrated a reduction in blood product usage and projected a decrease in mortality would be found if a larger number of patients were included. They also noted that a clear cut decrease in mortality was found when octreotide was combined with sclerotherapy, which is commonly performed in these patients.

As an Emergency Physician treating a patient with an Upper Gi Bleed it makes sense to utilize octreotide as a bridge to sclerotherapy.

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