Upper Gastrointestinal Haemorrhage

1. Establish large bore peripheral lines and if appropriate central venous access

2. Take blood for FBC, U&E, Creatinine, LFTs, Coagulation screen, G&H, GXM if high risk i.e.
   • Age $>$ 60 years
   • Haemodynamically unstable (Systolic BP $<$ 100 mmHg, Pulse $>$ 100)
   • Hb $<$ 10 g/dl on admission
   • Significant major organ disease

3. Pass a nasogastric tube

4. Pass urinary catheter and measure hourly urine output, see section 9.5

5. Infuse/Transfuse as needed to maintain red cell mass and to correct volume and coagulation defects

6. Endoscope all patients within 24 hours. Gastroenterology consult regarding sclerotherapy

7. Endoscope within 12 hours if
   • high risk (as above)
   • re-bleed
   • greater than 4 units of blood or plasma expander required to correct acute blood loss

8. Platelets should be given in patients with renal failure or bleeding secondary to aspirin or NSAIDs regardless of platelet count

9. FFP is given if transfusion exceeds 4 units of packed red blood cells

10. Keep patient warm

One unit of packed red blood cells (400 ml) gives l gram or 3% increase in Haematocrit. One pool of platelets increases platelet count by $5-10 \times 10^{3}$, give after 8 units of packed cells. Packed cells have maximum 10 days shelf life and decreases by 10% per day from the outset One unit of fresh frozen plasma (FFP) is given for every 4-6 units of packed red blood cells transfused, it gives all clotting factors except factor V and VII.