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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