A Bucket O’ Blood

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    A Bucket O’ Blood

    You are taking a water break during your resus shift when you hear “clinical upgrade, acute zone 1”.

    You rush back to see a 60-year-old patient holding a bucket of bright red blood and you find out that he has an extensive PMH including HepC cirrhosis.

    After handling the initial resuscitation, you consider which additional tests and meds to order when your colleague reminds you to also give ceftriaxone. Why would this help?

    UGIB in cirrhotics are due to varices until proven otherwise. These patients commonly have an active bacterial infection or are prone to developing one during their hospitalization (most commonly UTI > SBP > Resp > Bacteremia) [2]. Studies suggest that antibiotics – targeting enteric bacteria — reduce mortality, bacterial complications, and even rebleeding [3, 4]. You can use ceftriaxone (1g/day) or IV quinolones.

    Want to learn more about intubating the GI bleeder? Check http://emcrit.org/podcasts/intubating-gi-bleeds/

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    1. Johns Hopkins Medicine Gastroenterology & Hepatology. Portal Hypertensive Bleeding. <https://gi.jhsps.org>
    2. Uptodate: General principles of the management of variceal hemorrhage
    3. Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L. Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding. Cochrane Database Syst Rev. 2002;(2):CD002907.
    4. Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soares-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding – an updated Cochrane review. Aliment Pharmacol Ther. 2011;34(5):509.
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