Gastric Ultrasound in the Management of Emergency Department Patients with Upper Gastrointestinal Bleeding: A Case Series and Sonographic Technique

Background: Gastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality. Objectives: Very early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration. Discussion: Gastric ultrasound (GUS) is an adjunct tool that may help make such decisions and is supported by anesthesiology society guidelines to assess aspiration risk. Conclusion: In this manuscript, we present a case series of ED patients with upper GIB in whom emergency physicians (2 fellowship-trained attendings and 2 senior residents facile with point-of-care ultrasound) performed GUS. As a supplement to the clinical examination, this sonographic "lavage" (i.e., using GUS in patients with upper GIB) helped predict aspiration risk, support diagnostic reasoning, and expedite early goal-directed management and appropriate disposition. We also provide a step-by-step tutorial using high-quality media, as well as a novel algorithm for translation of this technique to the bedside for emergency physicians.