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All right.

Now on to medications for you. All right.

Now on to medications for upper GI bleeds.

So we've intubated our sick 42-year-old alcoholic GI bleed patient.

We've given some fluids to maintain organ profusion.

We've ordered up some red cells.

It's time to start thinking about meds to help stop the bleeding until the patient gets scoped. So let's start with PPI's. Just to remind the listeners,

the typical dose of something like pantoprazo as an example is 80 milligram bulles, followed by an

8 milligram per hour infusion. So Dr. Swam and Nathan,

what does the literature tell us about the value of giving IV proton pump inhibitors,

PPIs in the acute upper GI bleeder in the ED? Nothing could be more part of routine practice than the PPI bolus and drip on these patients,

and nothing could have less literature to defend its role than giving a PPI bolus and drip.

But we all do it. We all do it, and our GI docs all ask for it. So let's cut right to the bottom

line here, and let's talk about numbers needed to treat because we've got good literature to tell us.

When we talk about preventing death and decreasing transfusion, the NNT for PPI is infinity. It's a little eight on its side, which means that there aren't enough patients in the world with upper GI bleed for us to save somebody's life by giving him a PPI.

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