Emergency Department, ICU and Inpatient Clinical Pathway for the
Evaluation/Treatment of Children with Upper Gastrointestinal (UGI) Bleed
Signs, Symptoms Concerning
for Hemorrhagic Shock
for Hemorrhagic Shock
- Tachycardia
- Altered Mental Status
- Anxiety, lethargy, obtundation
- Hypotension, Perfusion Abnormality
- Delayed capillary refill
- Decreased pulses
- Skin
- Pallor
- Concern for Upper GI Bleed
- History and Physical Exam
- Differential Diagnosis for UGI Bleeding
- Significant Pre-existing Conditions
- Assess need for further evaluation
- Historical concern for significant bleeding
- At risk population
- Abnormal VS
- Signs or symptoms of anemia
No Concern for Hemorrhagic Shock
Hemorrhagic Shock
Minimal Bleeding Benign Cause Likely |
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|
Concern for Significant Blood Loss | |
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Evaluation |
|
Treatment |
|
Reassessment |
|
Disposition | Review w/ GI indications for admission vs. discharge with follow-up |
Active Bleeding | |
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Evaluation |
|
Treatment |
|
Reassessment |
|
Disposition |
|
- Discharge
- VSS, well appearing, tolerating PO
- No ongoing bleeding
- Workup reassuring
- Consider outpatient medications, follow-up plan
Inpatient Management
Admit to Gen Peds or subspecialty team
Continue to evaluate for hemorrhagic shock
ICU Management
Posted: July 2023
Editors: Clinical Pathways Team
Editors: Clinical Pathways Team
Evidence
- ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding
- Acute Upper Gastrointestinal Bleeding in Childhood: Development of the Sheffield Scoring System to Predict Need for Endoscopic Therapy
- Timing of Endoscopy for Acute Upper Gastrointestinal Bleeding
- Prevalence of, and Risk Factors for, Upper Gastrointestinal Tract Bleeding in Critically Ill Pediatric Patients
- Frequency of Upper Gastrointestinal Bleeding in a Pediatric Intensive Care Unit
- Frequency and Prophylaxis of Upper Gastrointestinal Hemorrhage in Critically Ill Children: a Prospective Study Comparing the Efficacy of Almagate, Ranitidine, and Sucralfate. The Gastrointestinal Hemorrhage Study Group
- Endoscopic Management of Gastrointestinal Bleeding in Pediatrics
- Therapeutic Endoscopy for the Control of Nonvariceal Upper Gastrointestinal Bleeding in Children: A Case Series
- The Management of Antithrombotic Agents for Patients Undergoing GI Endoscopy
- Octreotide Therapy for Control of Acute Gastrointestinal Bleeding in Children
- Randomized Pragmatic Trial of Nasogastric Tube Placement in Patients with Upper Gastrointestinal Tract Bleeding
- American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
- Gastrointestinal Bleeding in Children: Current Management, Controversies, and Advances
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