Abstract
Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.
Keywords:
Anticoagulant reversal; Gastrointestinal hemorrhage; Massive hemorrhage; Massive transfusion; Resuscitation; Thromboelastography.
Copyright © 2020 Elsevier Inc. All rights reserved.
MeSH terms
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Airway Management
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Anti-Bacterial Agents / therapeutic use
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Antibodies, Monoclonal, Humanized / administration & dosage
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Anticoagulants / adverse effects
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Antifibrinolytic Agents / therapeutic use
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Balloon Occlusion
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Blood Coagulation Factors / administration & dosage
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Blood Transfusion / methods
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Catheters
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Emergency Service, Hospital
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Factor Xa / administration & dosage
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Gastrointestinal Hemorrhage / diagnosis
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Gastrointestinal Hemorrhage / etiology
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Gastrointestinal Hemorrhage / therapy*
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Humans
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Infusions, Intraosseous
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Infusions, Intravenous
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Medical History Taking
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Physical Examination
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Proton Pump Inhibitors / therapeutic use
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Recombinant Proteins / administration & dosage
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Resuscitation
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Thrombelastography
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Vasoconstrictor Agents / therapeutic use
Substances
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Anti-Bacterial Agents
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Antibodies, Monoclonal, Humanized
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Anticoagulants
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Antifibrinolytic Agents
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Blood Coagulation Factors
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PRT064445
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Proton Pump Inhibitors
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Recombinant Proteins
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Vasoconstrictor Agents
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prothrombin complex concentrates
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idarucizumab
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Factor Xa