Hemorrhage Initial Management

Regardless of subsequent intervention, the first step in the management of any patient presenting with an acute variceal hemorrhage is adequate resuscitation. This is accomplished using a combination of blood volume replacement, with a goal hematocrit of 25 to 30%, along with fresh frozen plasma to correct any coagulopathy. It is important to avoid over-transfusion, however, which can lead to an increase in portal pressure that may potentiate further bleeding or rebleeding. In actively bleeding patients, intubation should also be considered for airway protection. Finally, patients should receive prophylactic antibiotics, because they have been shown to improve survival. A reasonable choice is norfloxacin 400 mg every 12 hours. Once these initial steps have been taken (and in the case of pharmacologic therapy, concurrently), diagnostic endoscopy should be performed and appropriate endo-scopic therapy initiated as indicated.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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