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GI Bleed (Primary Survey (Breathing: RR, SpO2, Oxygenation as necessary,…
GI Bleed
Primary Survey
Breathing: RR, SpO2, Oxygenation as necessary
Circulation: HR, BP, cap refill, 2x IV access, Bloods (FBC, UEC, coags, BUN, group and save, LFT's, VBG/ABG), Fluid resus, analgesia
Airway: Is it patent? NBM
Disability: AVPU/GCS, pupils, BGL
DRS
Exposure: Temp
Fluids: IDC, fluid balance chart
Investigations
PR exam
Other to rule out DDx: ECG, CXR, blood cultures, FAST scan, pelvic X-ray, etc
Colonoscopy
Endoscopy +/- urgent
Further management
Risk stratify as per Rockall or Blatchford scores which take into account BUN, SBP, sx, etc
IV PPI e.g. pantoprazole to promote clots and vasoconstriction
Stop any NSAIDs
Surgical referral
Somatostatin + IV Abx if suspected variceal bleed
Consider HDU/ICU admission