Upper GI Bleed.pdf - T

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Upper GI Bleed Competition: SimWars 2019, Cork Round: Semi-Finals Participants: Medical Students (Clinical Years). Team of 5. Learning Objectives • Identification of the deteriorating patient. • Diagnosis of upper gastrointestinal bleed (UGIB). • Risk factors and causes of UGIB. • General principles for management of UGIB. • Management of bleeding oesophageal varices. • Indications for blood transfusion. • Teamwork and communication. • Seeking specialist help early. • Scenario Location: Ward Patient: Manikin (With Voice – Can give history) Condition: Bleeding oesophageal varices with haemodynamic instability. 67 year old male, on day two of admission for alcohol withdrawal and investigation of deranged liver function tests, has an episode of hematemesis on the ward. Team are the medical emergency response team called to assess. Initial Observations: RR 20, Sp02 96% RA, HR 110 (Sinus), BP 85/60, Temp 37.4 GCS: 15 Appearance: Pale, hospital gown with blood stained front. Past Medical: “Alcoholic (5-10 cans cider/day), Smoker 20/day.” “Sees consultant every few months for a hard liver and some fluid on belly” “Seizures before, most recent 4 months ago” “Gallbladder removed aged 28” Medications: Spironolactone 25mg BD, Bisoprolol 2.5mg, Thiamine 100mg OD. Allergies: NKDA Dr Tiarnán Byrne This work is licensed under a Creative Commons Dr James Condren Attribution-NonCommercial-ShareAlike 4.0 International License Progression of Scenario Upper GI Bleed Failure to Recognise & Recognition of UGIB Treat UGIB Intial Resuscitation & Work-Up Blood Pressure Falls Haemodynmically Instability Persists Asystolic Arrest Need for Blood Products & ICU Recognised Transfer for Urgent Endoscopy Scenario Ends Results Exam Cardiac: HS I+II normal, nil added. Tachycardic. Respiratory: Airway clear. Air entry normal bilaterally. Gastrointestinal: Palpable liver edge 5cm below costal margin. Abdomen slightly distended (fluid) but non-tender. Bowel sounds positive. DRE normal, no blood. Neuro: No focal neurology. ECG: Sinus Tachycardia VBG: With Appropriate Resuscitation Time 00:00 00:02 00:04 00:06 00:08 10:00 Condition Alert Verbal Verbal Verbal Verbal Verbal Pulse 110 (Sinus) 118 115 110 110 100 BP 92/62 84/60 86/52 90/54 87/60 87/55 Sp02 98% RA 96% 96% 96% 96% 96% RR 22 24 24 24 24 24 Without Appropriate Resuscitation Time 00:00 00:02 00:04 00:06 00:08 10:00 Condition Alert Verbal Pain Unresponsive Pulse 110 (Sinus) 118 124 142 BP 92/62 80/56 76/56 70/50 Arrest Arrest Sp02 96% RA 96% 90% 82% RR 22 24 30 30 Source: Wikipedia. Creative Commons Licence https://en.wikipedia.org/wiki/Chest_radiograph#/media/File:Normal_posteroanterior_(PA)_chest_radiograph_(X-ray).jpg