1. TYPE
1.1. UPPER
1.1.1. Esophageal - Duodenum
1.1.1.1. Duodenal Ulcer
1.1.1.2. Gastric Ulcer
1.1.1.3. Varices
1.1.1.4. กลุ่มอาการ Esophageal "Mallory Weiss Syndrome"
1.1.1.5. Esophageal/Gastric Cancer
1.2. LOWER
1.2.1. Duodenum - Rectum
1.2.1.1. Hemorrhoids
1.2.1.2. Diverticulosis
1.2.1.3. CA Colon/Rectum
2. MEDICATION
2.1. 1.Proton Pump Inhibitors
2.1.1. Pantoprazole 80 mg vien bolus then 8mg/hr (pre/post EGD)
2.2. 2.H2 Receptor Antagonist
2.3. 3.Antacids
2.4. 4.Sucralfate
2.5. 5.Somastatin
3. NURSING CARE
3.1. 1.Hypovolemic Shock
3.1.1. IV Fluid: Crystalloid
3.1.2. Blood Component : PRC , FFP , Plt
3.1.2.1. Hb < 7g/dl , INR > 1.5
3.1.3. Follow up Lab:CBC Coagulation DTX
3.1.4. Urine output > 0.5cc/kg/hr
3.2. 2.Risk for Hypoxia
3.2.1. Oxygen Support
3.3. 3.Recurrent Patient
3.3.1. Introduce self-care practices
4. SENGSTAKEN BLAKEMORE TUBE (SB-tube) or Gastroesophageal Ballon Temponade (GEBT)
4.1. Routine ETT Before SB Tube
4.2. Inflate Gastric Balloon in 2 Steps 50cc - X-Ray - 200-250cc in case Gastric/Esophageal varices
4.3. Inflate Esophageal balloon <45 mmHg
4.3.1. Avoid necrosis (<6Hrs.)
4.4. 1-kg Traction compress GE Jungtion -- Reduce EV blood floe
5. SIGHS & SYMPTOMS
5.1. UPPER
5.1.1. 1.Hematemesis > 1000ml
5.1.2. 2.Coffee Ground
5.1.3. 3.Melena
5.1.4. 4.Shock
5.2. LOWER
5.2.1. 1.Hematochezia (bleeding per rectal)
5.2.2. 2.Shock
6. TREATMENT
6.1. Endoscopic treatment
6.1.1. Epinepheine with Thermal ablation
6.1.2. Clip
6.2. Surgery Treatment
6.2.1. High risk for Forrest's classification , size ulcer > 2 cm
6.2.2. Posterior duodenal ulcer
6.2.3. GU
6.2.4. Prolong shock
6.3. Duodenal Ulcer Surgery
6.3.1. Simple suture to stop bleed
6.3.2. Refractory duodenal ulcer with complication
6.3.3. Antrectomy + Vagotomy (if stable)