PT - JOURNAL ARTICLE AU - S. S. Hanna AU - W. D. Warren AU - J. T. Galambos AU - W. J. Millikan, Jr TI - Bleeding varices: 1. Emergency management DP - 1981 Jan 01 TA - Canadian Medical Association Journal PG - 29--41 VI - 124 IP - 1 4099 - http://www.cmaj.ca/content/124/1/29.short 4100 - http://www.cmaj.ca/content/124/1/29.full SO - CMAJ1981 Jan 01; 124 AB - The aim of the emergency management of bleeding varices is to stop the hemorrhage nonoperatively if possible, avoiding emergency shunt surgery, an operation that has a higher mortality than elective shunt surgery. Patients with an upper gastrointestinal hemorrhage should undergo endoscopy immediately to verify the diagnosis of bleeding varices. They can then be categorized according to whether they stop bleeding spontaneously (group 1), continue to bleed slowly (group 2) or continue to bleed rapidly (group 3). Group 1 patients are discussed in the second part of this two-part series. Group 2 patients are initially treated with vasopressin given intravenously; those who fail to respond should undergo emergency angiography and receive vasopressin intra-arterially. If this fails, patients at low surgical risk should undergo urgent shunt surgery; those at high risk do better with endoscopic sclerotherapy. Group 3 patients are also given an intravenous infusion of vasopressin. Patients at low surgical risk who continue to bleed then receive tamponade with a Sengstaken--Blakemore tube. If this fails, they undergo emergency creation of an H-shaped mesocaval shunt. Patients at high surgical risk who fail to respond to vasopressin given intravenously are next treated intra-arterially. If this fails they are given either endoscopic or transhepatic sclerotherapy.