{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 9, Ep 1 of 2: Nonvariceal UGIB","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/40269688\"></iframe>","width":"100%","height":180,"duration":866,"description":"Nonvariceal upper GI bleeding worked as a fixed sequence: perfusion first, diagnosis second, endoscopy third. The first hour moves mortality more than the scope does. Covers resuscitation, transfusion thresholds, pre-endoscopy pharmacology, risk scores, anticoagulant reversal, Forrest-directed endoscopic therapy, and post-hemostasis medical management.\n \nTopics covered\n\nResuscitation and airway in massive UGIB\nRestrictive transfusion threshold\nPre-endoscopy PPI and erythromycin\nGlasgow-Blatchford risk stratification\nTiming of endoscopy within 24 hours\nAnticoagulant and antiplatelet management\nForrest classification and dual therapy\nH. pylori eradication and secondary prevention\n \n \nKey decisions\n\nTransfuse red cells at hemoglobin 7 in most patients; aim 8 to 10 only in acute coronary syndrome; the stable cirrhotic variceal bleeder does worse with a liberal target.\nHigh-dose IV PPI targets intragastric pH above 6 to stop clot lysis; give 72 hours after hemostasis of a high-risk lesion, then oral taper.\nGlasgow-Blatchford 0 or 1 identifies the very-low-risk patient for outpatient endoscopy; Rockall needs the scope and AIMS65 predicts ICU need, not the go-home patient.\nNon-variceal endoscopy within 24 hours with no benefit before 6; tranexamic acid is not used in acute UGIB.\nReverse warfarin with 4-factor PCC plus IV vitamin K, dabigatran with idarucizumab, Xa inhibitors with andexanet alfa reserved for life-threatening bleeding; resume early because late risk is thrombotic.\nHigh-risk Forrest stigmata (spurting, oozing, non-bleeding visible vessel) get dual therapy: epinephrine plus a thermal method or clip; epinephrine alone is inadequate; over-the-scope clip rescues the recurrent bleeder.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Upper GI Bleeding...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}