National Institute for Health and Clinical Excellence:

Acute upper GI bleeding: NICE guideline

http://guidance.nice.org.uk/CG141/NICEGuidance/pdf/English

Great Britain’s National Health Service has a group called the National Institute for Health and Clinical Excellence (NICE); this group has recently put out guidelines for the management of Upper GI Bleeds. Thanks to my friend, Cliff Reid, for bringing these guidelines to my attention.

The Guidelines

Before endoscopy, calculate a Blatchford Score consider discharge if the score is zero.

After endoscopy, calculate a Rockall Score, this helps determine disposition

Transfuse massively bleeding patients as per local protocols, realizing that both under- and over-transfusion are bad

Do not give platelets if the patient is not bleeding. If they are bleeding, give plts for count < 50,000.

Offer FFP to pts with fibrinogen < 1 g/L or INR > 1.5

Use PCC for patients taking warfarin and are actively bleeding

Do not use Factor VIIa until other methods have failed

Offer endoscopy for severe acute bleeding immediately after resuscitation

Do not offer PPI to patients with non-variceal upper GI bleeding unless endoscopy reveals an ulcer

Offer them if the patient has stigmata of recent hemorrhage on endoscopy

If patient still bleeding after intial endocscopy or rebleeds after repeat endoscopy, go to IR, then to surgery

In variceal bleed, they recommend terlipressin until definitive haemostasis or for 5 days

GIVE PROPH ABX for suspected variceal bleeds

Go to TIPS if endoscopic treatment is unsuccessful

What is EMCrit drinking?

Rodenbach, an amazing Flemish Sour Ale

Now on to the Podcast…