• Robert James Adrian, Peter Alsharif, Hamid Shokoohi, and Stephen Alerhand.
• Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: robert.james.adrian@gmail.com.
• J Emerg Med. 2025 Jan 1; 68: 667266-72.

BackgroundGastrointestinal bleeding (GIB) is a common condition in the emergency department (ED) with high incidence and mortality.ObjectivesVery early risk stratification of GIB patients can sometimes be a challenge. The decision to intubate these patients is multifactorial and requires careful consideration.DiscussionGastric ultrasound (GUS) is an adjunct tool that may help make such decisions and is supported by anesthesiology society guidelines to assess aspiration risk.ConclusionIn 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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