Do you know?

  1. Melena suggests a proximal GI bleeding source in which there is time for enzymatic breakdown to transform blood to melena. How much blood in the stomach does it take to cause melena?
  2. What is a Morel-Lavallee lesion
  3. What is an Essex–Lopresti injury?
  4. What is the number one cause of fatal ingestions in children under 5 years of age (in the US)?
  5. What topical medication has been recently reported as a cause of methemoglobinemia in infants and children?

Management of a massive GI bleed

For known upper GI bleed, give PPI as soon as access is obtained – it makes endoscopy easier. Decreasing the acidity provides benefit acutely by improving platelet function, and in the long run by adding mucosal protection. Start with an 80 mg bolus followed by 8 mg/hr of Esomeprazole or Pantoprazole.