Medical

Massive upper GI bleed / hematemesis

Before / During / After / Pitfalls

Before

• Resuscitate hemorrhagic shock: blood, access, pressor only as bridge if needed, GI/ICU pathway.
• Two suctions, head-up/positioning, and backup operator/device ready.
• Plan for contaminated view and rapid desaturation.

During

• Suction continuously; do not chase a view through pooling blood.
• Minimize hypotensive induction; reassess after PPV.
• Confirm with waveform EtCO2 despite contamination.

After

• Secure tube, continue massive transfusion/bleed control, decompress stomach when appropriate.
• Reassess shock and ventilator settings.
• Communicate high aspiration risk.

Pitfalls

• Under-resuscitated induction.
• Single suction.
• Tube dislodgement during procedures/transport.