Approach to the Critical Patient

Hemodynamic instability

Shock recognition

Airway and resuscitation priorities

Airway protection

Resuscitation targets

Monitoring and escalation

Monitoring bundle

Escalation triggers

Immediate consults

Consultation triggers

History

Presentation pattern

Classic presentation

Vomiting context

Alarm features

High-risk symptoms

Associated GI symptoms

Risk factors

Modifiable risk factors

Non-modifiable risk factors

Past medical and medication history

Relevant past history

Medications contributing to bleeding

Special historical considerations

Vomiting etiology

Physical Exam

Vital signs and hemodynamic assessment

Hemodynamic stability assessment

General and HEENT exam

General appearance

HEENT findings

Chest and abdominal exam

Chest examination

Abdominal examination

Liver disease and rectal exam

Stigmata of chronic liver disease

Rectal examination

PITFALLS

Common diagnostic errors

Differential Diagnosis

Life-threatening diagnoses

Cannot-miss diagnoses

Common upper GI bleeding causes

Peptic ulcer disease

Erosive esophagitis

Mallory-Weiss tear

Less common causes

Dieulafoy lesion

Gastric and esophageal malignancy

Hemobilia

Laboratory Tests

Initial hemorrhage workup

Complete blood count

Coagulation studies

Metabolic and renal assessment

Basic metabolic panel

Liver function tests

Additional targeted labs

Type and screen or crossmatch

Lactate

Troponin

Urine pregnancy test

Diagnostic Tests

Scoring Systems

Glasgow-Blatchford Score (GBS)

AIMS65 Score

Shock Index

Rockford (Forrest) Classification

MRI

MRI role in Mallory-Weiss tear

MRI for Boerhaave syndrome assessment

CT

CT chest with oral contrast

CT angiography

Chest X-ray

Ultrasound

Point-of-care ultrasound applications

Abdominal POCUS

Upper endoscopy (EGD)

Disposition

Discharge criteria

Safe discharge criteria

Admission criteria

Floor or general ward admission

ICU or high-dependency admission

Consultation and transfer

GI consultation

Surgical consultation

Transfer criteria

Treatment

Initial resuscitation

Vascular access and volume

Blood product transfusion

Acid suppression therapy

Proton pump inhibitor

Transition to oral PPI

Antiemetic therapy

Ondansetron

Rationale

Endoscopic therapy

Indications for endoscopic intervention

Epinephrine injection

Hemoclipping

Band ligation

Combination therapy

Salvage therapies

Transcatheter arterial embolization

Surgical intervention

Coagulation reversal

Warfarin reversal

DOAC reversal

Antiplatelet management

Special Populations

Pregnancy

Physiologic considerations in pregnancy

Diagnostic approach

Treatment modifications

Geriatric

Physiologic considerations

Risk factors in older adults

Management considerations

Pediatrics

Epidemiology in children

Diagnostic considerations

Treatment modifications

Background

Epidemiology

Incidence and prevalence

Outcomes data

Pathophysiology

Mechanism of injury

Vascular anatomy

Additional precipitants beyond vomiting

Therapeutic Considerations

Endoscopic timing evidence

Endoscopic therapy evidence

Transfusion strategy

Natural history

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for Mallory-Weiss Tear

References

Guidelines and key sources

Primary evidence sources

Management guidelines

Boerhaave and esophageal perforation references

Special population references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.