52 Gastrointestinal Bleeding
BUY
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D. Omeprazole, Clarithromycin (OC)
1. 14 days of therapy.
2. Omeprazole (Prilosec) 40 mg PO qd for 14 days, then 20 mg qd for an
additional 14 days of therapy.
3. Clarithromycin (Biaxin) 500 mg PO tid.
E. Ranitidine-Bismuth-Citrate, Clarithromycin (RBC-C)
1. 28 days of therapy.
2. Ranitidine-bismuth-citrate (Tritec) 400 mg PO bid for 28 days.
3. Clarithromycin 500 mg PO tid for 14 days.
4. Efficacy is 70-80%; expensive
10. Symptomatic Medications:
-Trimethobenzamide (Tigan) 100-250 mg PO or 100-200 mg IM/PR q6h prn
nausea OR
-Prochlorperazine (Compazine) 5-10 mg IM/IV/PO q4-6h or 25 mg PR q4-6h
prn nausea.
11. Extras: Upright abdomen, KUB, CXR, ECG, endoscopy. GI consult, surgery
consult.
12. Labs: CBC, SMA 7&12, amylase, lipase, LDH. UA, Helicobacter pylori
serology. Fasting serum gastrin qAM for 3 days. Urea breath test for H pylori.
Gastrointestinal Bleeding
1. Admit to:
2. Diagnosis: Upper/lower GI bleed
3. Condition:
4. Vital signs: q30min. Call physician if BP >160/90, <90/60; P >120, <50;
R>25, <10; T >38.5
C; urine output <15 mL/hr for 4h.
5. Activity: Bed rest
6. Nursing: Place nasogastric tube, then lavage with 2 L of room temperature
normal saline, then connect to low intermittent suction. Repeat lavage q1h.
Record volume and character of lavage. Foley to closed drainage; inputs and
outputs.
7. Diet: NPO
8. IV Fluids: Two 16 gauge IV lines. 1-2 L NS wide open; transfuse 2-6 units
PRBC to run as fast as possible, then repeat CBC.
9. Special Medications:
-Oxygen 2 L by NC.
-Ranitidine (Zantac) 50 mg IV bolus, then continuous infusion at 12.5 mg/h
[300 mg in 250 mL D5W over 24h (11 cc/h)], or 50 mg IV q6-8h OR
-Cimetidine (Tagamet) 300 mg IV bolus, then continuous infusion at 50 mg/h
(1200 mg in 250 cc D5W over 24h), or 300 mg IV q6-8h OR
-Famotidine (Pepcid) 20 mg IV q12h.
-Vitamin K (Phytonadione) 10 mg IV/SQ qd for 3 days (if INR is elevated).
Esophageal Variceal Bleeds:
-Somatostatin (Octreotide) 50 mcg IV bolus, followed by 25-50 mcg/h IV
infusion (1200 mcg in 250 mL of D5W at 11 mL/h).
