65 year old male with no known past medical history presenting with constipation that has been worsening over the past month. Patient is a daily smoker and has not seen a doctor in twenty-five years. He has tried docusate, senna, and miralax at home with no improvement in symptoms.
A 60 yo female with a history of DM and HTN presents to the ED with fever and AMS. Family reports that this morning she appeared confused and generally ill, prompting a call to 911. In the ED, her vital signs are as follows: T: 39C; HR:120; BP: 85/40; RR:26; SpO2: 97%.
A 55 year old male with a history of cirrhosis and HTN presents to the ED with progressively worsening abdominal pain and distension for the past week. Vitals are as follows: T101F HR110 BP150/95 SpO297% RR20.
We encounter patients with upper GI bleeding frequently. While some of these are obviously ill and in need of urgent intervention and/or admission, others appear well and we might consider sending them home - but how do we decide who is low risk enough to discharge? Is there an evidence based approach to risk stratify patients with upper GI bleeds?