Vasopressin Nitroglycerine Paste Therapy

-Vasopressin (Pitressin) 20 U IV over 20-30 minutes, then 0.2-0.3 U/min [100 U in 250 mL of D5W (0.4 U/mL)] for 30 min, followed by increases of 0.2 U/min until bleeding stops or max of 0.9 U/min. If bleeding stops, taper over 24-48h AND -Nitroglycerine paste 1 inch q6h OR nitroglycerin IV at 10-30 mcg/min continuous infusion (50 mg in 250 mL of D5W).

10. Extras: Portable CXR, upright abdomen, ECG. Surgery and GI consults. Upper GI Bleeds: Esophagogastroduodenoscopy with coagulation or sclerotherapy; Linton-Nachlas tube for tamponade of esophageal varices. Lower GI Bleeds: Sigmoidoscopy/colonoscopy (after a GoLytely purge 6-8 L over 4-6h), technetium 99m RBC scan, angiography with embolization.

11. Labs: Repeat hematocrit q2h; CBC with platelets q12-24h. Repeat INR in 6 hours. SMA 7&12, ALT, AST, alkaline phosphatase, INR/PTT, type and cross for 3-6 U PRBC and 2-4 U FFP.

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