Upper GI Bleed protocol for Emergency Department: MUH (Print version MUH Policy).
Active resuscitation
- large bore IV lines
- early, aggressive IV crystalloids (NOT colloids)
- Group and Cross match and give blood if low HB or if large active bleeding even if normal Hb initially
- FBC, Coag, Bioprofile
- if unstable GI bleed (see below), consult Surgical team on call urgently
- The important initial management is aggressive resuscitation ± blood which is more important and urgent than endoscopy
Refer surgical
Agreed policy in MUH is that:
Patients should be referred urgently to the surgical service if unstable:
- active bleeding, ongoing malaena or haematemesis, even if Hb normal or
- history of large volume malaena passed or
- Hb <10 or
- SBP <100 or if BP normal but there are orthostatic symptoms/orthostatic hypotension (history of syncope with bleed) or
- Heart rate >100 (but patient on β blockers will not exhibit a tachycardia even if unstable GI bleed)
A normal Hb is not a reassuring sign if large amount or active bleeding. Print Version MUH Policy
Medical referral
Agreed policy in MUH is that:
Patients with upper GI bleeds that can be admitted under the medical team include: Stable GI bleed if all of below are fulfilled:
- Systolic BP >100 and
- Heart rate < 100 and
- No active bleeding and
- No orthostatic symptoms/↓BP or Hx of syncope associated with bleed and
- Hb > 10
Patients felt to have a stable GI bleed must be closely observed and reassessed regularly. If the above parameters change or if further bleeding occurs, (i.e. they develop features of an unstable bleed) surgical opinion must be sought urgently. Print Version MUH Policy