What is the emergency treatment of acute upper gastrointestinal bleeding?

Acute upper gastrointestinal bleeding is one of the most common
acute and critical illnesses in the emergency department.

The common causes are gastric and duodenal ulcers, ruptured esophagus-gastric varices, acute gastric mucosal lesions, gastric cancer, biliary hemorrhage, and cardia tear syndrome and so on .

Acute upper gastrointestinal bleeding is one of the most common

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Acute massive hemorrhage of the upper gastrointestinal tract is acute and changes rapidly, and measures should be taken to actively carry out rescue and treatment.
At the same time, standardizing the emergency diagnosis and treatment process is of great significance to improving the prognosis
.

Therefore, it is very important to construct a diagnosis and treatment process and actively carry out emergency treatment

Acute massive hemorrhage of the upper gastrointestinal tract is acute and changes rapidly, and measures should be taken to actively carry out rescue and treatment.

3 evaluations and 2 treatments, construction of the diagnosis and treatment process 3 evaluations and 2 treatments, construction of the diagnosis and treatment process 3 evaluations and 2 treatments, construction of the diagnosis and treatment process3 evaluations and 2 treatments, construction of the diagnosis and treatment process

According to the 2021 "Expert Consensus on the Emergency Diagnosis and Treatment Process of Acute Upper Gastrointestinal Bleeding", the process is constructed in accordance with "3 evaluations, 2 treatments", and strives for clinical operability and practicability
.

According to the 2021 "Expert Consensus on the Emergency Diagnosis and Treatment Process of Acute Upper Gastrointestinal Bleeding", the process is constructed in accordance with "3 evaluations, 2 treatments", and strives for clinical operability and practicability
.

According to the 2021 "Expert Consensus on the Emergency Diagnosis and Treatment Process of Acute Upper Gastrointestinal Bleeding", the process is constructed in accordance with "3 evaluations, 2 treatments", and strives for clinical operability and practicability

Diagnosis process

Diagnosis processDiagnosis process

Emergency assessment, stratified treatment

Emergency evaluation, hierarchical treatment emergency evaluation, hierarchical treatment emergency evaluation, hierarchical treatment

The patient's consciousness, airway, breathing and circulation should be evaluated first
.

After the initial diagnosis and identification of acute upper gastrointestinal bleeding, the Glasgow-Blatchford score (GBS) was used to determine the degree of risk of the disease

The patient's consciousness, airway, breathing and circulation should be evaluated first

Emergency treatment, keeping in mind the principles of treatment

Emergency treatment, keep in mind the principle of treatment of emergency treatment, keep in mind the principle of treatment of emergency treatment, keep in mind the principle of treatment

Patients with high-risk acute upper gastrointestinal bleeding should be treated urgently
.

The conventional measures are "OMI", namely oxygen, monitoring and establishment of venous access

Patients with high-risk acute upper gastrointestinal bleeding should be treated urgently

Acute upper gastrointestinal bleeding with unstable hemodynamics should be resuscitated in time to restore and maintain vital organ perfusion

Weigh the risks and benefits of blood transfusion and adopt the best blood transfusion strategy

After active volume resuscitation, persistent hypotension still exists.
In order to ensure the minimum effective perfusion of vital organs, vasoactive drugs can be used
.
Vasoactive drugs can be used in severe and persistent hypotension caused by hemorrhagic shock
.
However, there is currently a lack of high-level evidence to support it
.

When the cause of dangerous acute upper gastrointestinal bleeding is unknown, PPI and somatostatin can be combined intravenously for treatment, and adjustments can be made after the cause is clear
.
For unexplained dangerous acute upper gastrointestinal bleeding, although there is insufficient evidence to support it, when emergency gastroscopy intervention may be delayed, "empirical combination medication" can be adopted to maximize the possibility of reducing bleeding, serious complications and death , To create conditions for endoscopy or other follow-up treatments
.

When the cause of dangerous acute upper gastrointestinal bleeding is unknown, PPI and somatostatin can be combined intravenously for treatment, and adjustments can be made after the cause is clear
.
For unexplained dangerous acute upper gastrointestinal bleeding, although there is insufficient evidence to support it, when emergency gastroscopy intervention may be delayed, "empirical combination medication" can be adopted to maximize the possibility of reducing bleeding, serious complications and death , To create conditions for endoscopy or other follow-up treatments
.
When the cause of dangerous acute upper gastrointestinal bleeding is unknown, PPI and somatostatin can be combined intravenously for treatment, and adjustments can be made after the cause is clear
.

When there is a high degree of suspicion of varicose vein bleeding, prophylactic antibiotics are recommended
.
Because preventive use of antibiotics for varicose vein bleeding can significantly improve the prognosis, antibiotics should be used prophylactically when a high degree of suspicion of varicose vein bleeding
.

When there is a high degree of suspicion of varicose vein bleeding, prophylactic antibiotics are recommended
.
Because preventive use of antibiotics for varicose vein bleeding can significantly improve the prognosis, antibiotics should be used prophylactically when a high degree of suspicion of varicose vein bleeding
.
When there is a high degree of suspicion of varicose vein bleeding, prophylactic antibiotics are recommended
.

Comprehensive evaluation and speculation of the cause of bleeding 

Comprehensive evaluation, inferred cause ofbleedingComprehensive evaluation, inferred cause of bleeding 

The causes of acute upper gastrointestinal bleeding are divided into acute non-varices bleeding and varicose bleeding
.
Most of them are acute non-varices bleeding.
The most common causes include gastroduodenal peptic ulcer, upper gastrointestinal tumor, stress ulcer, acute and chronic upper gastrointestinal mucosal inflammation, and other causes include cardia mucosal tear syndrome , upper gastrointestinal arteriovenous malformations, Dieulafoy lesions
.
Iatrogenic factors include: nonsteroidal anti-inflammatory drug administration (the NSAIDs), in particular, antiplatelet drugs (such as aspirin), endoscopic mucosal resection / dissection (EMR / ESD) and the like
.

The causes of acute upper gastrointestinal bleeding are divided into acute non-varices bleeding and varicose bleeding
.
Most of them are acute non-varices bleeding.
The most common causes include gastroduodenal peptic ulcer, upper gastrointestinal tumor, stress ulcer, acute and chronic upper gastrointestinal mucosal inflammation, and other causes include cardia mucosal tear syndrome , upper gastrointestinal arteriovenous malformations, Dieulafoy lesions
.
Iatrogenic factors include: nonsteroidal anti-inflammatory drug administration (the NSAIDs), in particular, antiplatelet drugs (such as aspirin), endoscopic mucosal resection / dissection (EMR / ESD) and the like
.
The causes of acute upper gastrointestinal bleeding are divided into acute non-varices bleeding and varicose bleeding
.

Dynamically monitor changes in the condition and determine whether there is active bleeding
.
The vital signs, blood routine, blood coagulation function and blood urea nitrogen should be continuously monitored dynamically
.
In addition, the blood lactic acid level should be dynamically monitored to determine whether the tissue ischemia is improved and the effect of fluid resuscitation, and the fluid resuscitation plan should be optimized
.
In the process of further diagnosis and treatment, for persistent bleeding that is difficult to control with drugs, endoscopy, and interventional treatment, multidisciplinary diagnosis and treatment can be initiated, and surgical intervention if necessary
.

Dynamically monitor changes in the condition and determine whether there is active bleeding
.
The vital signs, blood routine, blood coagulation function and blood urea nitrogen should be continuously monitored dynamically
.
In addition, the blood lactic acid level should be dynamically monitored to determine whether the tissue ischemia is improved and the effect of fluid resuscitation, and the fluid resuscitation plan should be optimized
.
Dynamically monitor changes in the condition and determine whether there is active bleeding
.
The vital signs, blood routine, blood coagulation function and blood urea nitrogen should be continuously monitored dynamically
.
In the process of further diagnosis and treatment, for persistent bleeding that is difficult to control with drugs, endoscopy, and interventional treatment, multidisciplinary diagnosis and treatment can be initiated, and surgical intervention if necessary
.

Nursing points

Nursing points Nursing points

After the acute upper gastrointestinal bleeding is stable, the prognosis needs to be evaluated, and the condition should be closely observed, the degree of bleeding and hemostatic effect should be recorded, psychological care and life care, and preparations for rescue and surgery
.
In the prognosis assessment, the assessment includes the function of vital organs and the risk of rebleeding and death
.
After the prognosis evaluation is completed, according to the cause and evaluation results, it is recommended that the patient be transferred to a specialist department for re-diagnosis and treatment or follow-up after discharge
.

After the acute upper gastrointestinal bleeding is stable, the prognosis needs to be evaluated, and the condition should be closely observed, the degree of bleeding and hemostatic effect should be recorded, psychological care and life care, and preparations for rescue and surgery
.
When evaluating the prognosis, after the acute upper gastrointestinal bleeding is stable, the prognosis needs to be evaluated, and the condition should be closely observed, the degree of bleeding and hemostatic effects should be recorded, psychological care and life care, and preparations for rescue and surgery
.
The assessment includes the function of vital organs and the risk of rebleeding and death
.
After the prognosis evaluation is completed, according to the cause and evaluation results, it is recommended that the patient be transferred to a specialist department for re-diagnosis and treatment or follow-up after discharge
.

references

references

Emergency Physician Branch of Chinese Medical Doctor Association, Emergency Medicine Branch of Chinese Medical Association, etc.
Expert consensus on emergency diagnosis and treatment process of upper gastrointestinal bleeding in emergency[J].
Chinese Emergency Medicine,2021,1(1):1-10.

The Emergency Physician Branch of the Chinese Medical Doctor Association, the Emergency Medicine Branch of the Chinese Medical Association, etc.
Expert consensus on the emergency diagnosis and treatment process of upper gastrointestinal bleeding in emergency[J].
China Emergency Medicine,2021,1(1):1-10.
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