- 2 large bore IVs (or sheath introducer)
- Type and cross
- CBC & serial hemoglobin
- BUN/creatinine >30 suggests UGI if no history of renal failure (increased absorption/digestion of hb)
- More useful for diagnosing chronic occult bleeding (it could be positive for up to 2 weeks after an acute bleed)
- False-positive: vitamin C, red meat, methylene blue, bromide preparations, turnips, horseradish
- ECG (if >40 yo or if suspicious for silent MI, especially from demand ischemia)
- CXR (if suspect perforation)
NG Lavage Controversy
- Positive aspirate proves strong evidence for an upper GI source of bleeding
- Can assess presence of ongoing active bleeding
- Can prepare patient for endoscopy
- Aljebreen AM et al. Nasogastric aspirate predicts high-risk endoscopic lesions in patients with acute upper-GI bleeding. Gastrointest Endosc. 2004;59(2):172-178.
- Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011;74(5):971-980.