Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock. Correct management is required in such conditions. It is required to perform all tests such as endoscopy before medication. A platelet test is also an important test in such conditions. Medicines such as painkillers or antibiotics eg. ciprofloxacin, could decrease platelet count which can lead to thrombocytopenia. In such conditions wrong medication or management could be deadly. Blood transfusion is required in such conditions if the body loses more than 20 percent of body blood volume. Severe loss makes it impossible for the heart to pump a sufficient amount of blood to the body. In such conditions unmaintained blood volume could lead to Hypovolemic Shock. Note that an untreated patient could suffer cerebral atrophy.
Minimal blood loss
In cases that do not involve shock, the patient is generally administered a proton pump inhibitor, given blood transfusions, and kept NPO, which stands for "nil per os" until endoscopy can be arranged. Adequate venous access is generally obtained in case the patient suffers a further bleed and becomes unstable.
Significant blood loss
In a "hemodynamically significant" case of hematemesis, that is hypovolemic shock, resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood is administered, preferably by large bore intravenous cannula, and the patient is prepared for emergency endoscopy, which is typically done in theatres. Surgical opinion is usually sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary. Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level A cuffed endotracheal tube could be a life saving choice.
Techniques
Hematemesis, melena, and hematochezia are symptoms of acute gastrointestinal bleeding. Bleeding that brings the patient to the physician is a potential emergency and must be considered as such until its seriousness can be evaluated. The goals in managing a major acute gastrointestinal hemorrhage are to treat hypovolemia by restoring the blood volume to normal, to make a diagnosis of the bleeding site and its underlying cause, and to treat the cause of the bleeding as definitively as possible. The history should be directed toward confirming the presence of bleeding; estimating its amount and rapidity; identifying the source and potential specific causes; and eliciting the presence of serious associated diseases that might adversely affect the outcome. The information obtained is especially helpful in identifying situations that require aggressive management.
