Upper GI bleed Flashcards
What A-E this affect
Circulation
Airway
Vocalising
Blood in the mouth?
Breathing
Look:
Listen: cough, high risk for aspiration
Feel:
RR O2
ABG lactate, Hb (If peripherally shut down ABG)
CXR - **high risk for aspiration and check for perforation (pneumoperitoneum) **
Circulation
Look: peripheral shutdown, mottled
Listen: heart sounds
Feel: CRT, pulse
BP, HR, CRT: central and peripheral
Investigations:
1. Bloods: FBC, UE, LFT, CRP, G&S, cross-match, clotting
2. Imaging: Endoscopy
Management (consider they may be in hypovolaemic shock)
- Rehydrate - 500 mls STAT of NaCL
Transfuse - If SBP <90 -> call for help, major haemorrhage protocol, and crash call
Disability
PEARL
GCS
Glucose
Drug Charts (anticoagulants, NSAIDs)
Exposure
Abdo exam - check for signs of chronic liver disease, distention, melena in DRE
Rashes
Urinary catheter
**Lines/ drains: check no frank blood
Vomit bowels: coffee grains
Drug chart: NSAIDS, anti coagulation
Management of upper GI
Calculate:
**Blatchford score **
Then:
1. IV access and give crystalloids
2. Blood transfusion (O negative blood if shock stage 2-3 until crossmatch)
3. Correct clotting abnormalities (vitamin K, FFP)
4. Consider referal to ICU for central venous line
5. Catheter to monitor urine output: aim > 30 ml/ hour
Ugent endoscopy **Blatchford score ** calculates urgency of intervention: band ligation or sclerotherapy
If endoscopy fails -> surgery or emergency mesenteric angiography
IV ABx ceftriaxone
**Medical management: **
- Ulcer bleed -> omeprazole 80 mg IV STAT over 60-80’
- Variceal bleed -> terlipressin 2mg IV/ 6hours
Escalate:
- Crash call: Will get you people
- Major haemorrhage: will get you blood, and a porter
- Surgical on call
- Gastro on call: OGD
Management of major haemorrhage
Summary
Stages of shock:
