Sim Blog: Acute Upper GI Bleed #1

Sim Blog: Acute Upper GI Bleed #1

“A 61-year-old male is brought to the ER by paramedics with a history of 3 episodes of fresh haematemesis over the preceding 3 hours. No abdo pain or melaena.”
— PMH: Alcohol dependence, Chronic Liver Disease
 

Observations

A – Clear & self maintaining.

B – Rate 25, SpO2 98%. Room air.

C – Pulse 130, BP 87/60.

D – E4 V5 M6 pupils equal

E – Temp 36.9°C

Clinical Findings

  • Cold, sweaty and pale

  • Fresh blood visible around mouth and lips
 

Why We Simulated?

Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has not significantly improved over the past 50 years.

Learning Points

  1. Use local pro formas where available – they provide useful prompts when assessing severity and initiating treatment.

  2. In patients presenting with upper GI bleeds consider recruitment to the Halt-It trial.

  3. If a patient is bleeding and haemodynamically unstable despite appropriate resuscitation activate Massive Haemorrhage protocol.

Reference:

Positive Feedback

  • Good preparation pre-arrival, clear allocation of roles within team

  • Recognised massive GI bleed and resuscitated with blood

  • Early institution of variceal bleed care bundle
Edit & Peer Review by Jamie Sillett
Thank you, Manchester! (thoughts on #RCEM15)

Thank you, Manchester! (thoughts on #RCEM15)

Working in the Emergency Department: Is it just service provision or do our trainees actually learn?

Working in the Emergency Department: Is it just service provision or do our trainees actually learn?