Summary: National Institute for Health and Clinical Excellence: <br> <br> Acute upper GI bleeding: NICE guideline<br> <a href="http://guidance.nice.org.uk/CG141/NICEGuidance/pdf/English" target="_blank">http://guidance.nice.org.uk/CG141/NICEGuidance/pdf/English</a><br> <br> 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 <a href="http://resusme.em.extrememember.com/?p=6636">guidelines to my attention</a>.<br> <a href="http://guidance.nice.org.uk/CG141/NICEGuidance/pdf/English">The Guidelines</a><br> Before endoscopy, calculate a <a href="http://www.mdcalc.com/glasgow-blatchford-bleeding-score-gbs/">Blatchford Score</a> consider discharge if the score is zero.<br> <br> After endoscopy, calculate a <a href="http://www.gastrotraining.com/calculators/rockall-score">Rockall Score</a>, this helps determine disposition<br> <br> Transfuse massively bleeding patients as per local protocols, realizing that both under- and over-transfusion are bad<br> <br> Do not give platelets if the patient is not bleeding. If they are bleeding, give plts for count < 50,000.<br> <br> Offer FFP to pts with fibrinogen < 1 g/L or INR > 1.5<br> <br> Use PCC for patients taking warfarin and are actively bleeding<br> <br> Do not use Factor VIIa until other methods have failed<br> <br> Offer endoscopy for severe acute bleeding immediately after resuscitation<br> <br> Do not offer PPI to patients with non-variceal upper GI bleeding unless endoscopy reveals an ulcer<br> <br> Offer them if the patient has stigmata of recent hemorrhage on endoscopy<br> <br> If patient still bleeding after intial endocscopy or rebleeds after repeat endoscopy, go to IR, then to surgery<br> <br> In variceal bleed, they recommend terlipressin until definitive haemostasis or for 5 days<br> <br> GIVE PROPH ABX for suspected variceal bleeds<br> <br> Go to TIPS if endoscopic treatment is unsuccessful<br> What is EMCrit drinking?<br> <a href="http://pintley.com/beer/Rodenbach/3848/">Rodenbach</a>, an amazing Flemish Sour Ale<br> Now on to the Podcast…
