Discharge from the ED without inpatient endoscopy may be considered in patients with urea nitrogen < 18.2mg/dL; hemoglobin ≥ 13.0 g/dL for men,12.0 g/dL for women; systolic blood pressure ≥ 110 mm Hg; pulse < 100 beats/min; and absence of melena, syncope, cardiac failure, and liver disease, as they have < 1% chance of requiring intervention. (Conditional, low-quality evidence)
Blood transfusions should target hemoglobin ≥ 7 g/dL, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or co-morbidities such as coronary artery disease. (Conditional, low-to-moderate- quality evidence)
Pre-endoscopic IV PPI (eg, 80-mg bolus followed by 8-mg/h infusion) may be considered to decrease the proportion of patients who have higher-risk stigmata of hemorrhage at endoscopy and who receive endoscopic therapy. However, proton pump inhibitors do not improve clinical outcomes such as further<unk> , surgery, or death. (Conditional, high-quality evidence)
If endoscopy will be delayed or cannot be performed, an IV PPI is recommended to reduce further<unk> . (Conditional, moderate-quality evidence)
Patients with<unk>  GI<unk>  should generally undergo endoscopy within 24 hours of admission, following resuscitative efforts to optimize hemodynamic parameters and other medical problems. (Conditional, low-quality evidence)
In patients who are hemodynamically stable and without serious co-morbidities, endoscopy should be performed as soon as possible in a non-emergent setting to identify the substantial proportion of patients with low-risk endoscopic findings who can be safely discharged. (Conditional, moderate-quality evidence)
In patients with higher-risk clinical features (eg, tachycardia, hypo- tension, bloody emesis, or nasogastric aspirate in hospital) endoscopy within 12 hours may be considered to potentially improve clinical outcomes. (Conditional, low-quality evidence)
Intravenous infusion of erythromycin (250mg approximately 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes. (Conditional, moderate-quality evidence)
Nasogastric or orogastric lavage is not required in patients with<unk>  GI<unk>  for diagnosis, prognosis, visualization, or therapeu- tic effect. (Conditional, low-quality evidence)
Upper GI bleeding guidelines
Hinchey classification for diverticulitis
Glasgow-Blatchford Bleeding Score
ECGs by Diagnosis
PERC rule
GI antibiotics
DVT ultrasound
Prehospital protocol pediatric anaphylaxis