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Vascular Access
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Fluid Resuscitation
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Strict Fluid balance
Correct electrolyte abnormalities |
Medication |
Information |
IV Octreotide (Recommend that this drug is kept available within the wards emergency drug cupboard.) |
Dose: Loading dose:1mcg/kg (max 50mcg/hr) over 5 mins, then maintenance infusion 1-3 mcg/kg/hr (max 50mcg/hr) Preparation: Loading dose – no dilution required. Maintenance infusion - Dilute 500mcg octreotide in 40ml with 0.9% sodium chloride (1ml/hr = 12.5mcg/hr) Notes
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IV Vitamin K (phytimenadione) |
Dose: 300mcg/kg; max 10mg as slow IV injection over 5-10 minutes |
IV Omeprazole |
Dose: 2mg/kg/day; max 40mg/days IV infusion over 20 minutes OR |
IV Esomeprazole |
Dose: Under 1 year of age: 0.5 mg/kg, 1-11 years old body weight up to 20kg – 10mg, 1-11 years old body weight over 20kg – 20mg, 12-17 years old – 40mg as IV infusion over 20 minutes |
IV Tranexamic acid |
Dose: 10 mg/kg max dose 1g as slow IV injection over 10 minutes. Note: evidence for benefit is unclear and is not in the national guidance but may help to prevent rebleed. Do not delay giving Octreotide.. |
Haemoglobin |
Initial Hb may be normal if taken after initial blood loss and falsely reassuring Aim for Hb of 90g/l |
Platelets |
If <100x109/l may warrant platelet transfusion |
INR |
>1.5 may warrant FFP or octoplas |
Fibrinogen |
Target >2g/l may warrant Cryoprecipitate |
Urea and Creatinine |
High urea may indicate a significant bleed took place or insidious bleeding. If raised creatinine alongside low Hb and high Urea think HUS. |
Neonates |
1 month - 2 years |
> 2 years |
Swallowed maternal blood |
Oesophagitis |
Oesophageal varices |
Haemorrhagic disease of the newborn |
Gastritis |
Gastric Varices |
Coagulopathy |
Gastro-duodenal ulcer |
Mallory Weiss tears |
Oesophagitis |
NSAID-induced ulcers |
Dieulafoy's lesions |
Stress Gastritis |
Oesophageal varices |
Swallowed blood from epistaxis |
Gastroduodenal ulcers |
Gastric Varices |
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Duplication Cyst |
Foreign body ingestion (especially 'button batteries') |
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Necrotising Enterocolitis |
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Document Version:
1.0 Lead Authors: Dr Jennie Pridgeon, PHU Dr Emma Knight, PHU Dr Reynella Morenas, HHFT |
Approving Network:
Wessex Gastroenterology, Hepatology and Nutrition Network Date of Approval: Pending Review Due: Pending |
PIER Contact |
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