Assessment
A rapid clinical assessment must be made in a patient with an acute upper GI bleed. Attempts to resuscitate patients with severe shock should begin immediately. It is extremely important to gain early venous access as there is a potential risk of peripheral shutdown. If the patient is conscious, she or he should be questioned about previous episodes of bleeding, dyspepsia and jaundice, and intake of alcohol and drugs.
Pulse, blood pressure, respiratory rate, and state of peripheral circulation should be noted and recorded by the nurse. A blood sample should be taken for cross-matching and to determine haemoglobin, haematocrit, platelet count, and prothrombin time.
A risk assessment score (Rockall score) has been developed for patients with acute GI bleeding. A series of independent risk factors (Box 1) is scored and the total score predicts clinical outcome (Rockall, 1996).