History - please note:
- Co-morbidities especially CCF, IHD, renal, malignancy
- Presence or absence of chronic liver disease
- Alcohol use
- Medications including anticoagulants and NSAIDs
Examination – please note specifically: Postural BP drop Rectal examination findings
Please calculate and record Blatchford Score (see below)
Investigate: FBC, U&E, LFTs, clotting studies, Group and save / cross match
Cross match:
6 units: ?variceal bleed
4 units: fresh melaena on PR, postural drop >15mm Hg, Syst BP <100 mm Hg
G&S: All others
Treatment
- IV access, iv fluids. Patients with cirrhosis should receive ceftriaxone 1g iv.
- Nil by mouth
- Consider urinary catheter
- Seek senior advice if patient > 60 years, tachycardic, postural hypotension or hypotensive.
Admission
- Stable upper GI bleeds will be admitted under medicine unless by agreement with with the surgical and gastroentrology teams.
-Unstable upper GI bleeds (systolic BP < 100 on more then 2 occasions or HR >100 after 1l fluid iv) will be admitted under surgery.
