Patient ID ______________
DOB_______ Postcode____
Name
PLEASE FOLLOW THIS PATHWAY FOR PATIENTS
WITH UPPER GASTROINTESTINAL BLEED
1 Please use this Pathway for patients with any of the following symptoms:
HAEMATEMESIS.
COFFEE GROUND VOMITUS (witnessed by staff)
MELAENA OR DARK BLOOD STOOLS
N.B. ALL PATIENTS SHOULD HAVE ENDOSCOPY FOLLOWING GI BLEED ( National
guideline/standard )
RESUSCITATION & RISK ASSESSMENT-ALL PATIENTS
2. Is Patient at High Risk
NO
YES
Older patient (>60 years)
History or signs of liver disease
Severe coexisting cardiorespiratory / renal disease
On anticoagulants or coagulopathy
Melaena on rectal examination
Large (observed) vomit of fresh blood
Haemoglobin < / = 10g/dl
Systolic BP < 100mmHg
Pulse > 90 / min
If YES to any above patient -HIGH RISK See (3)
If No to all above patient - LOW RISK See (5)
3
AS THIS PATIENT IS HIGH RISK ARRANGE:
Large bore IV access
Consider CVP
(Use Colloid for resuscitation)
Replace Intravascular Volume
Give omeprazole IV 80 mgs stat + 8 mgs hourly for 72 hours
via Infusion
Chest X-ray
Give Oxygen
U&E
Keep starved but for sips of water
Monitor ECG
In appropriate cases
PT
Group, save and crossmatch Blood
No. of units …………
ECG
Blood gases
Referred to Physicians on call at ……………….. hrs &
Gastroenterologist on call informed
at ……………….. hrs (High Risk patients must be jointly managed)
Condition & proposed treatment discussed with patient / other
Yes
No
4 Not Responding To Resuscitation CONTACT The Following:
1. Gastroenterology Registrar
Time: ………………………… hrs.
2. Anaesthetist
Time: ………………………… hrs.
3. General Surgeon
Time: ………………………… hrs.
Doctors Signature
Time
Notes
© RLUHT
D:\106747873.doc
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Feb 2003
Review Feb 2004
Patient ID ______________
DOB_______ Postcode____
Name
PLEASE FOLLOW THIS PATHWAY FOR PATIENTS
WITH UPPER GASTROINTESTINAL BLEED
5
THIS PATIENT IS LOW RISK
For fast track Endoscopy from SSOW, A&E Dept./AMAU
IV access
Group & Save Serum
Transfer to SSOW /AMAU
Keep patient starved for 6 hours before Endoscopy
Inform A&E senior to arrange Endoscopy
Condition & proposed treatment discussed with patient / other Yes
No
N.B. IVI H2 Antagonists & Proton Pump Inhibitors must not be given routinely
IF PATIENT ADMISSION REQUIRED - ADMIT TO RLUH SITE ONLY
NOTES
FURTHER MANAGEMENT
GASTRO UNIT
Check consent obtained prior to Gastroscopy Yes
No
Date:
Time:
ENDOSCOPIST’S DIAGNOSIS FOLLOWING ENDOSCOPY:
RISK OF FURTHER BLEEDING
Was any endoscopic therapy used No
Yes
Any evidence of:
Stigmata?
Yes
Upper major lesions? Yes
Varices?
Active bleeding?
No
No
please state:
Yes
Yes
No
No
ENDOSCOPISTS MANAGEMENT COMMENTS:
BSG Guideline No 22: Management of Non variceal upper gastrointestinal haemorrhage 2002
© RLUHT
D:\106747873.doc
Page 2
Version 3
Feb 2003
Review Feb 2004