Patient Resuscitation and Timing of Endoscopy

Patients with acute NVUGIB should undergo endoscopy soon after presentation. Most authors suggest endoscopy within 12 to 24 hours (Spiegel et al, 2001), although randomized controlled outcome data are lacking. The largest randomized trial (N = 124) demonstrated that early endoscopy (< 12 hours) is safe and effective, decreases transfusion requirements compared to delayed endoscopy (12 to 24 hours), but does not decrease mortality (Lin et al, 1996). Resource utilization (hence costs) appears to be reduced with early endoscopy via a decrease in the length of stay and the number of postdischarge physician visits (Lee et al, 1999).

Patients with hemodynamic instability or suspected severe bleeding should undergo more urgent endoscopy following an initial resuscitation. Facilities for urgent after-hours endoscopy must be available. The ideal settings for resuscitation and endoscopy in this scenario are the emergency department, intensive care unit, or endoscopy suite with the support of experienced nurses. Prior to the endoscopy, one should consider (1) airway protection via endotracheal intubation, (2) central venous access, (3) correction of coagulopathy with plasma, (4) consultation with an anesthesiologist (propofol sedation), and (5) consultation with a general surgeon and intensivist.

It is preferable to start blood transfusion before endoscopy unless the severity of the bleeding demands earlier assessment.

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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