- MOANS – difficult BVM
- LEMON – difficult laryngoscopy
- The Two Minute Drill: How I Prep My Airways
- The Bloody Airway: The Trauma Airway and the GI bleeder
- The Obstructed Airway: Angioedema and Deep Space Infections
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.
The first step in managing an acute upper GI bleed is to stabilize the patient with airway and volume restoration. An acidic environment promotes platelet disaggregation, fibrinolysis, and impairs clot formation, hence the utility of using PPI therapy. There is no proven mortality benefit to using PPI therapy, although it is still commonly used in practice. Early upper endoscopy within 24 hours of presentation is recommended in most patients because it confirms the diagnosis and allows for targeted treatment.