National Institute for Health and Clinical Excellence:
Acute upper GI bleeding: NICE guideline
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.
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…
- EMCrit 290 – Decompensated Hypothyroidism and Myxedema with Dr. Arti Bhan - January 23, 2021
- EMCrit 289 – Ketamine Only Intubation Paper with Brian Driver - January 12, 2021
- EMCrit 288 – Neurogenic Shock & Should we be Using Vasopressors for Hemorrhagic Shock? - December 29, 2020