 Welcome back to emergency medicine video on GI Bleed. In this part we will discuss the treatment for upper GI Bleed. We will first talk about general or empiric treatment and then go into the specific details for different causes of upper GI Bleeds. Without knowing the cause for the GI Bleed, the general approach as with all emergency medicine patients is start with ABC. We want to make sure the patients are always intact, they're protecting their way and they're ventilating and oxygenating adequately. Then we turn our attention to circulation. We assess their circulation by addressing their blood pressure and their end organ perfusion. We start resuscitation by using IV crystalloids, such as ringoslactate or normal saline. In large amount of bleeding, often blood will be given. If the patient is on an anticoagulant, we will also give reversal agents to reverse them. We often start with these empirical treatment until we know more about the patient's specific causes. As discussed before, upper GI Bleed can be caused by a few specific causes. They include esophagitis and gastritis, malaria-wise tears, Peptic ulcer disease, esophageal varices or more rarely gastric varices, and the dreaded aorta enteric fistula. Let's look at the specific treatment for each cause. For gastritis and esophagitis, patients often have quite small amount of bleeding. There's no urgent specific treatment. Remember that a lot of these patients have esophagitis and gastritis based on use of NSAIDs and alcohol. We will try to talk to the patients to stop these. Sometimes anti-acid therapy is started when the patient goes home. Similarly, in malaria-wise tear, again the amount of bleeding is tend to be small. No specific treatment is needed. However, we might need to investigate why the patient is vomiting repeatedly. Malaria-wise tear usually settles down at his own when the patient is not vomiting anymore. In Peptic ulcer disease, patients can bleed quickly. The main treatment for bleeding ulcer is treatment during endoscopy. Endoscopy will allow you to identify the bleeding vessel. Multiple types of treatment can be used during endoscopy to cause hemostasis of the bleeding vessel. In terms of medical treatment, sometimes you might see a proton-pum inhibitor given to the patient. If the patient now has a surgical abdomen because the ulcer has perforated, then surgery should be consulted. For varices, again endoscopy is the main treatment. During endoscopy, these esophageal varices can be injected or banded to decrease bleeding. There are also a few medications we can give as well. They include octreotide, which decrease the blood flow to the gut and therefore decreases bleeding. One of the other medications we don't often think about is an antibiotic, usually a fluoroquinolone. It should be given to patients who have cirrhosis with variceobleed. The antibiotic decreases infection and mortality. If none of these work, the last resort for bleeding varices is a Blakemore tube. It is a tube that's inserted like a nasal gastric tube. Its main function is a balloon that tamponauts these esophageal varices. The last cause is aorta enteric fistula. Once it's being diagnosed, the patient will need to undergo surgery very quickly. There is no specific treatment for it that we can do in the emergency department, but you can imagine the patient will need a lot of fluids and probably blood for resuscitation. In summary, in this clip, we discuss the treatment of patients with upper dry bleed. The general empiric treatment include fluid, blood, and anticoagulant reversal. Specific treatment will depend on the cause of the upper dry bleed. In the next part, we will discuss the treatment of patients with lower GI bleed. Thank you for watching.