Tasty Morsels of EM 112 – #FRCEM GI Bleeding

4 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

I’m using NICE 2012 as reference document here

How should we risk assess GI Bleeds?

  • Blatchford
    • Hb
    • Urea
    • systolic
    • male sex
    • melaena
    • syncope
    • liver disease
    • heart failure
  • sometimes used to stratify out patient or in patient
  • NICE suggests >0 as reason to admit

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How should we manage GI Bleeds?

  • platelets if <50 and active bleeding
  • FFP if INR>1.5 (or PCC if warfarin obviously)
  • endoscopy should immediately follow resus in those who need it
  • other scopes should be within 24 hrs
  • do not use PPIs pre scope
  • terlipressin (2mg) and antibiotics for suspected varices
  • NICE has no mention of balloon tamponade in the ED but it likely still has a role

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One Reply to “Tasty Morsels of EM 112 – #FRCEM GI Bleeding”

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