A 44 yo male presents complaining of abdominal pain. As your basic differential for abdominal pain swirls through your head, you are a bit surprised to walk in the room and see the patient sitting upright, vomiting bright red blood all over himself. Time to shift gears doc.....
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?