Management of Coffee Ground Emesis

Initial Assessment and Stabilization

Evaluate hemodynamic stability including vital signs, as coffee ground emesis may represent upper GI bleeding which can lead to hypovolemic shock in approximately 15% of cases, according to the American Gastroenterological Association 1, 2
Assess for volume depletion and provide aggressive fluid resuscitation with isotonic fluids (10-20 mL/kg boluses of normal saline) as needed, as recommended by the American Academy of Allergy, Asthma, and Immunology 2
Consider nasogastric tube lavage in ventilated patients only, as this procedure can increase risk of gagging, vomiting, and aerosolization in unsedated patients, according to the American College of Gastroenterology 1

Consider alternative diagnostic modalities such as CT angiography if patient is hemodynamically stable but upper GI bleeding remains in the differential, as suggested by the American College of Gastroenterology 1
Document and photograph emesis when possible to guide management decisions, as recommended by the American College of Gastroenterology 1

Initiate proton pump inhibitor therapy with high-dose continuous infusion (80 mg bolus followed by 8 mg/hour for 72 hours) for patients with suspected active bleeding, according to the American College of Gastroenterology 1
Administer antiemetics to control ongoing vomiting, with ondansetron (5-HT3 antagonist) considered first-line due to superior efficacy and fewer side effects, as recommended by the American Society of Health-System Pharmacists 3

Correct any electrolyte abnormalities, particularly in patients with prolonged vomiting, as recommended by the American College of Physicians 4
Consider scheduled rather than as-needed antiemetics for persistent nausea/vomiting, according to the American Society of Health-System Pharmacists 3