Esophagogastroduodenoscopy, even with modern flexible fiberscopes, is associated with occasional life-threatening complications including perforation, hemorrhage, and various cardiopulmonary events. In the upper gastrointestinal bleeder, especially the elderly or those with active bleeding, risks may be appreciably higher, especially with respect to pulmonary aspiration, other cardiopulmonary events, and rebleeding. The importance of a good history and physical examination with special attention to drug history, bleeding disorders, dysphagia, or underlying cardiac, pulmonary, or hepatic disease is crucial. Sedatives should be used with caution and in the minimal dose necessary to produce the desired effect. Nasal O2 should be used if hypoxia exists. EKG should be performed in all patients, and cardiac monitoring carried out during the procedure if the clinical status dictates. Resuscitative equipment should be readily available and the endoscopic team should be versed in its use. Careful explanation of the procedure is mandatory for good patient cooperation and safety. Finally, vital signs, color, and sensorum should be closely monitored by a nurse during the procedure and following it until sedation wears off.
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