\n
Initial management:<\/u><\/strong><\/p>\n\n- ABC stabilization<\/li>\n
- Obtain access<\/li>\n
- Fluid resuscitate<\/li>\n
- Make NPO \/ confirm last PO intake<\/li>\n
- Hold anticoagulation \/ reverse anticoagulation if needed<\/li>\n<\/ul>\n
After initial management:<\/u><\/strong><\/p>\n\n- Pain \/ nausea control \u2013 do not delay for surgical evaluation (data proves that opiates do not obscure the diagnosis)<\/li>\n
- Obtain labs and imaging<\/li>\n
- Place blood products on hold if you anticipate significant bleeding (PRBCs, FFP, platelets)<\/li>\n
- Insert NG tube, on suction if concern for obstruction<\/li>\n
- Start antibiotics if concern for perforated viscus or infection (zosyn, meropenem, cipro\/flagyl)<\/li>\n
- Consult surgery STAT \u2013 use buzz words: peritonitic, rigid, elevated lactate, free air<\/li>\n
- Transfer to higher level of care (typically transfer to surgery service if going to the OR)<\/li>\n<\/ul>\n
<\/div>\nUGI Bleed<\/span>\n
UGI Bleed<\/h3>\n
![\"\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2025\/01\/UGI-bleed-1024x712.png\")
<\/p>\n
Stabilization \u2013 should be FIRST step while beginning to consider etiology\/diagnostics:<\/u><\/strong><\/p>\n\n- Establish access (2 large bore IVs \u2013 16 gauge or cordis)<\/li>\n
- Fluid resuscitation<\/li>\n
- Transfuse (if patient is actively bleeding with reasonable concern, you should transfuse immediately and do not need to wait for labs)<\/li>\n
- Consult Gastroenterology vs VIR<\/li>\n<\/ul>\n
Diagnostics:<\/u><\/strong><\/p>\n\n- Endoscopy is first choice and typically preferred within 24 hours, for non-variceal bleeding, and perhaps within 12 hours for variceal bleeding.<\/li>\n
- CT angiography can detect active bleeding and provide a target for VIR particularly\n
\n- Consider patient\u2019s stability when planning for a CT scan<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
Medications:<\/u><\/strong><\/p>\nAdminister appropriate medications as indicated by patient scenario and comorbidities<\/p>\n
\n- IV PPI for acid suppression and prevention of further erosion\n
\n- Pantoprazole 80 mg IV bolus x1, then 40 mg IV BID<\/li>\n<\/ul>\n<\/li>\n
- Prokinetics to improve gastric visualization (Erythromycin or Metoclopramide) [rarely given]<\/li>\n
- Vasoactive medications variceal bleeding (Somatostatin)\n
\n- Octreotide drip: 100 mcg bolus x1, then 50 mcg\/hour infusion<\/li>\n<\/ul>\n<\/li>\n
- Antibiotics for upper GI bleed in cirrhosis\n
\n- Ceftriaxone 1g IV daily (preferred over fluoroquinolone) \u2013 goal to administer prior to endoscopy<\/li>\n<\/ul>\n<\/li>\n
- TXA: Deemed to not be an effective treatment for GI bleeding. Administered in this given concern for oropharyngeal bleeding.<\/li>\n<\/ul>\n
Don\u2019t forget to hold antihypertensives and anticoagulants<\/p>\n
Transfusion protocol:<\/u><\/strong><\/p>\nMassive transfusion protocol:<\/p>\n
\n- Activated by making a phone call to the blood bank\n
\n- First round: 6 units of PRBCs, 6 units of FFP, and 1 unit of platelets<\/li>\n
- Second round: 6 units of PRBCs, 6 units of FFP, and 1 unit of cryoprecipitate<\/li>\n<\/ul>\n<\/li>\n
- If patient does not have type and screen, you can activate emergency blood by filling out a pink slip to administer uncross-matched blood<\/li>\n
- Trend CBC [RBCs, platelets], PT\/INR, PTT [FFP], and fibrinogen [cryoprecipitate]\n
\n- Goal Hgb >7, Platelets >50, INR 1.5, fibrinogen >150 or evaluation via thromboelastogram (Qstat)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<\/div>\nTransfusion Products for Hemostasis<\/span>\n
![\"\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2026\/02\/table.png\")
<\/div>\n","protected":false},"excerpt":{"rendered":"Flow of a rapid response: Introduce yourself and your role loudly Stand at the foot of the bed Eyeball patient quickly \u2013 ABC\u2019s, if unresponsive ask if there is a pulse Intro Timeout Team introductions \u2013 roles and names Primary nurse sign out (SBAR: Situation, Background, Assessment, Recommendation) Interventions Determine disposition Debrief with the team … Read more<\/a><\/p>\n","protected":false},"author":112673,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"layout":"","cellInformation":"","apiCallInformation":"","footnotes":"","_links_to":"","_links_to_target":""},"division-or-center":[],"class_list":["post-67308","page","type-page","status-publish","hentry","odd"],"acf":[],"yoast_head":"\nRapid Response Guide | Department of Medicine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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![\"RAPID\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2024\/05\/Screenshot-2024-05-06-at-1.14.08\u202fPM-1024x415.png\")
<\/p>\n![\"\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2024\/04\/Screenshot-2024-04-25-at-1.49.03\u202fPM-1024x418.png\")
<\/p>\n<\/div>\nAltered Mental Status<\/span>\n![\"\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2024\/09\/altered-mental-status-1024x707.png\")
<\/p>\n![\"\"](\"https:\/\/www.med.unc.edu\/medicine\/wp-content\/uploads\/sites\/945\/2025\/01\/Screenshot-2025-01-13-at-4.33.51\u202fPM-1024x434.png\")
<\/p>\n