Patient Details

NHS number: ......................................

Hospital Number: ................................ Date: …………………......
Last name: ............................................ Time: …………………….
First name: ...........................................
D.O.B: ..................................................
UGI BLEEDING CARE BUNDLE (WITHIN 24 HOURS)
1. Assess symptoms:
oMelaena o Hematemesis o Syncope o Haematochezia
Recognition 2. o Signs of peritonism (consider involving surgeons + CT scan)
3. o PR exam
Note: Examination should include PR to confirm melaena and differentiate from fresh PR bleeding.

NEWS: ………………. BP: ……………… PR: …………… RR: …………… SP02………………….

o Keep patient NBM
o 2x Large bore cannula(16G)
o IV fluids (aim MAP>65mm Hg)
Check o FBC oU&E oLFT oClotting & Fibrinogen oGroup and Save oVBG oECG
o Catheterise (if required) and monitor fluid balance.
Inv: Hb: …….… Platelets: ……………… INR: ……… PT: ……….. Urea: ……… T.Bil:……… Alb:…..
Blood transfusion required: Yes o No o
o Transfuse if Hb<70 g/L or massive bleeding, aim for 70-100g/L
o Transfuse platelets if Platelets< 50,000 and actively bleeding
Resuscitation Coagulopathy: Yes o No o
1.Patient on anti-coagulants: Yes o (Warfarin o , DOAC o, LMWH o, Antiplatelets o) No o
Consider reversal of anticoagulants –Refer to DBTH guidelines for general guidance o
(If in doubt, contact on-call haematologist)
2.Suspected variceal bleeding with coagulopathy Yes o No o If yes, follow as below.
If PT prolonged give IV Vitamin K 10 mg stat o
If PT>20 seconds (or INR>2)- give FFP (2-4 units) o
3.Suspected non-variceal bleeding with coagulopathy: Yes o No o If yes, follow as below.
INR>1.5, APTT>1.5X or Fibrinogen <1g/L, give FFP o

Total GBS score: ………………………… (See back page for GBS calculator)
Risk o If GBS=0, consider discharge and book outpatient endoscopy
o If GBS ≥1, consider admission after discussion with medical team/senior.

o Suspend all other antithrombotic including LMWH (unless recent coronary stent, coronary
stents on dual antiplatelets, VTE in < 3 months, mechanical valve; discuss with cardiologist,
haematologist, or gastroenterologist)
o Stop NSAIDS
History or stigmata of liver disease/cirrhosis?
If yes, treat as variceal bleed and add decompensated cirrhosis care bundle.
Management Suspected Variceal bleed
o Start Terlipressin 2 mg QDS for 72 hours (If Contraindicated o PVD/Severe IHD/previous
CVD- discuss with senior before starting Terlipressin)
o Prescribe prophylactic antibiotics as per Trust protocol (IV Co-amoxiclav/Cefuroxime, for
penicillin allergic: Ciprofloxacin)- Refer to DBTH guidelines for further guidance
o IV PPI (Stat and OD)
Suspected Non-Variceal bleed
o IV PPI (stat and OD)

o Referral for endoscopy (If needs urgent endoscopy liaise with On-Call Endoscopist)
Refer Date and Time of referral: …………………………
(See back page for approach to endoscopy unit)

o Endoscopy within 24 hours

o Review endoscopy report
Review o Post-haemostasis antithrombotic plan

Note: Massive haemorrhage (ongoing severe bleeding e.g., 150 mls/min, clinical shock, 1 volume loss (around 4 L) in 24 hours- Activate major
haemorrhagic protocol +/- ITU review. (Check trust guideline) o YES o NO
 Approach to Endoscopy Unit

• Doncaster patients:
GI Bleed service from 7 AM to 7 PM, 7 days a week

If urgent, discuss with GI bleed consultant on-call.

In non-urgent, send the referral to endoscopy department.

Overnight – Discuss with GIM consultant on-call if urgent before referral to Sheffield.

• Bassetlaw patients:

GI Bleed service from 7 AM to 7 PM, 7 days a week (Covered from DRI)

Working hours, discuss with BDGH endoscopy department first before considering transfer to DRI.

Outside working hours, arrange transfer to DRI. Inform medical registrar at Doncaster.

Overnight – Discuss with GIM consultant on-call if urgent, before referral to Sheffield.

GLASGOW BLATCHFORD SCORE (GBS) CALCULATOR:

Parameter Score
Blood urea (mmol/L)
≥6.5 – <8 2
≥8 – <10 3
≥10 – <25 4
≥25 6
Haemoglobin (g/L) in men
≥120 – <130 1
≥100 – <120 3
<100 6
Haemoglobin (g/L) in women
≥100 – <120 1
<100 6
Blood pressure - systolic (mmHg)
100 – 109 1
90 – 99 2
<90 3
Other
Pulse ≥100 per minute 1
Presentation with melaena 1
Presentation with syncope 2
Hepatic disease 2
Cardiac failure 2

Total Score: ……… /23

Signature: ………………………………………….