Generic Periop Flashcards
(209 cards)
1
Q
why is a preop assessment carried out
A
to assess patient’s medical and physical state before surgery, determining possible complications and seeing what can be done to optimise a patient’s health preop
2
Q
list the medications specifically asked about in the preop assessment
A
- heparin
- warfarin
clopidogrel - steroids
- contraceptive pill
- HRT
3
Q
why can steroids be a problem in surgery
A
steorids can cause adrenal suppression - as cortisol is usually increased during surgery; suppression may result in decreased BP or circulatory collapse during surgery
4
Q
list the risk factors for PONV
A
- female
- motion sickness
- duration of surgery
- diabetes
- laparoscopic surgery
- previous PONV
(each score one point)
5
Q
list the preop bloods
A
FBC, INR/clotting, electrophoresis, u + e, LFT, lipids, glucose, HbA1C, TFT, G+S
6
Q
list some of the preop investigations done in the preop assessment
A
ecg cxr msu pregnancy mrsa
7
Q
how is a patient who tests positively for mrsa in preop assessment be treated
A
the planned op may need to be delayed. treatment includes antibacterial wash, nose cream, side room admittance if urgent surgery
8
Q
what is APACHE scoring
A
classification system rating severity of patien’s risk of dying in hospital; takes into account factors such as core temp, HR, BP, creat, age, chronic illness
9
Q
what are high risk respiratory patients going for operations
A
asthma, COPD +/- steroid therapy. need to get this optimal
10
Q
why should diabetes patients be put first on the list for operations
A
prevent hypo
11
Q
which cardiac conditions increase operative risk
A
cvd/hf.arrhythmia/ihd
12
Q
how may alcoholism affect a patient going for an operation
A
may be tolerant to BZDs, anaesthetic agents e.g. propofol requiring higher doses
13
Q
how may obesity affect patients going for operations
A
may require higher O2 concs, make BP measurement less reliable, iv access more difficult
14
Q
list some neurological/neuromuscular conditions significant in patients having surgery
A
malignant hyperthermia, myasthenia gravis, MS, stroke, Parkinson’s, muscular dystrophy, MND, myasthenic syndromes, epilepsy, dementia, Guillain Barre
15
Q
what should a preop referral letter for a diabetic patient ideally contain
A
HbA1C, BP, wieght, details of complications, written information if drug regimen changes need to be made
16
Q
how should insulin therapy during surgery be administeres
A
in 0.45% NaCl and glucose, with KCl to maintain electrolyte balance,
17
Q
how are diabetic patients managed perioperatively in terms of drug regimen alterations
A
- put first on list
- stop long acting insulin night before
- SC insulin omitted in morning if morning surgery; if op in afternoon then give morning insulin with breakfast
18
Q
how often should you check blood glucose in a patient with diabetes, having surgery
A
hourly intraop then two hourly post op
19
Q
how do you manage diabetic patients intraoperatively
A
set up infusion pump with sliding scale insulin
20
Q
how do you manage diabetic patients post op
A
continue IV insulin + dextrose post op until patient can manage to feed
finger prick blood glucose every 2 hours
21
Q
how do you manage a non insulin-dependent diabetic who is undergoing surgery
A
- if poorly-controlled treat as per DM1
- do NOT igve long acting sulfonylureas on morning of surgery
- start SC/IV insulin if having major op
- take oral hypoglycamics as normal on preceding day and stop on morning of surgery
22
Q
what is a PICC line
A
peripherally-inserted central catheter, which is a form of iv access for a prolonged period of time
23
Q
what may PICC lines be used for
A
chemo, extended abx, tpn
24
Q
list some of the veins that a central line (or central venous catheter) may be inserted into
A
internal jugular or other veins including subclavian, axillary, femoral
25
what do central lines give an indication of
right atrial pressure therefore RV preload
26
what is the dose of cyclizine
50mg
27
what is the mech of action of cyclizine
anticholinergic/antihistaminic
28
what is the mech of action of ondansetron
5ht3 receptor antag
29
what is the mech of action of metoclopramide
D2 anatgonist
30
what is the dose of metoclopramide
10mg tds
31
what is the mech of action of prochlorperazine
D2 antagonist
32
what is the mech of action of hyoscine bromide
anticholinergic
33
what are the side effects of anticholinergics
drowsiness and xerostomia
34
what are the side effects of 5ht3 antagonists
confusion, dizziness, tachy
35
what are the side effects of dopamine atagonists
EPSE, resp depression, dystonia, restlessness, drowsiness
36
what is delirium (post op s/e)
organically-caused decline from previous cognitive function. has a fluctutating course, clouding of consciousness, behavioural changes, arousal changes, perceptional changes, sleep-wake cycle disturbance
37
what is dementia
long term gradual decline in cognitive function, with memory disorders, personality change, problems with language/emotional motivation/ (different types and underlying causes)
38
what does POCD stand for
post operative cognitive dysfunction
39
what is Post-op cognitive dysfunction
short-term decline in cognitive function (compared to before surgery) lasting a few days-weeks post op. distinct from delirium (does not share all the features).
40
which post op complications are expected to occur within the first 4 days post op
acute mi, pyrexia due to atelectasis, cva
41
which post op complications are expected within the first 7 days after surgery
renal impairment/failure
| post op urinary retention
42
which post op complication is expected within days 5-10 post op
delerium tremens
43
which post op complications are expected within days 7-10 post op
chest infeciton, wound infection, uti, secondary haemorrhage
44
which post op complicatoins are expected from days 10 onwards from operation
dvt, pe, wound dehisence
45
how should significant post op blood loss +/- shock be managed, or even a late secondary haemorrhage
surgical exploration to find cause
46
list some of the resp complications that may occur post op
pulmonary collapse, infection, resp failure, plueral effusion, pneumothorax, ARDS
47
what is the reason that heart problems may occur post op
diseased heart may find it difficult to respond to increased demand in the post op period, e.g. acute hf, mi, arrhythmias etc may occur
48
list some of the complications associated with IV administration in an operative setting
bruising, haematoma, phlebitis, venous thrombosis, air embolus, site infection,
(if arterial cannula - rarely artery occlusion)
49
which arrhythmia is the commonest to occur post op, and may be due to haemodynamic disturbance
af
50
what are the most common types of shock seen as complications post op
hypovolaemic, cardiogenic, septic
51
what are the common features of cardiogenic and hypovolaemic shock
decreased bp, increased hr, sweating, vasoconstriction
52
what are the initial features of septic shock
hyperdynamic circultion, fever, rigors, warm vasodilated periphery, bounding pulse
53
what are the later features of septic shock
hypotension, peripheral vasoconstriction, oliguria, multisystem failure
54
list some of the renal post op complications
urnairy retention - overflow incontinence
renal failure
uti
55
what factors can increase chance of urinary retention occuring as a post op complication
pelvic/groin/perineal op
spinal/epidural anaesthesia
post op pain, anaesthetic drugs
56
list the three steps of virchows triad
increased coagulability, endothelial damage, stasis
57
list the risk factors for dvt
- obesity
- age
- prolonged op
- hip/pelvic surgery
- varicose veins
- pregnancy
- malignancy
- previous dvt
58
what adjustments are made for patients on the cocp having surgery
stop cocp 4 weeks before surgery, with alternative contraceptive cover
59
which two types of compression are used on the leg for patients undergoing surgery
TED graduated compression stockings, and mechanical calf compression (Intermittent Pneumatic Compression)
60
how is a dvt treated
SC LMWH and Warfarin. LMWH is stopped once fully anticoagulated, and warfarin is continued for 3-6months. inr maintained at 2-3
61
is pe's continue to occur depsite anticoagulation post op etc, what measure can be taken
ivc filters
62
describe epidural anaesthesia
continuous infusion of anaesthetic + opioid into the epidural space, set to a certain rate.
63
how long can an epidural catheter remain in place for
up to 5 days
64
list some of the causes of epidural anaesthesia failure
misplacement, displacement, inadequate analgesia, intolerable side effects
65
what are some complications of epidural anaesthesia
cephalad spread causing resp distress
| permanent neurological damage
66
describe PCA
programmed pump delivers small predetermined doses of a drug (usually opiate) with a minimum period between doses (lock out)
67
what is a common setting for pca morphine
1mg, minimum 5 min intervals
68
what are some of the downsides to pca
patient must understand how it works, and have the required manual dexterity to operate it
69
what layers are gone through in order to insert an epidural
skin, subcut tissues, supraspinous ligament, interspinous ligament, ligamentum flavum, then enter the epidural space (dura mater on innermost)
70
why may patients who have had operation be more likely to get renal failure
recued perfusion to kidneys due to hypovolaemia, water depletion etc., s well as exacerbation by nephrotoxic agents, sepsis and hypoxia
71
list some of the things that can cause airway obstruction periop
obstruction by tongue, foreign bodies, layngeal spasm, laryngeal oedema, bronchospasm/bronchial obstruction
72
how is airway obstruction managed
recovery position
| chin lift jaw thrust, guedel airway, o2, may need to reintubate
73
what should pao2 be
>13kpa
74
what is defined as too low an oxygen kpa
less than 6.7kpa
75
what are the clinical and xray features of ards
impaired oxygenation, diffuse lung opacification on CXR and reduced lung compliance,
76
list some of the causes of post op ards
TRALI, pulmonary or systemic sepsis, aspiration of gastric contents
77
what are some of the clinical features of ards
tachypnoea, increased ventilatory effort, restlessness, confusion,
78
describe the pathophysiology of ards
thought to be due to inflammatory reaction abd release of cytokines, damaged vasculr endothelium, capillary leakage -> cause interstitial and alveolar oedema
79
what is the management of ards
a-e, ventilatory support, peep (positive end expiratory pressure), treat underlying cause
80
what are light's crteria indicating that an effusion is an exudate
- pleural;serum protein >/ 0.5
- pleural:serum lactate >/ 0.6
- pleural fluid lavtate dehydrogenase >/ 2/3 upper limit for serum LD
81
what periop factors increase the risk of pulmonary collapse for surgical patients
- inability to breathe deeply (e.g. pain) and cough up secretions
- anaesthetics and surgery
- impaired diaphragmatic movement
- oversedation
- cilia paralysis due to inhaled anaesthetics
82
how may post op pulmonary collapse be prevented
encourage patient to breathe deeply, cough and mobilise
may need chest physio
o2 by mask for hypoxia
(assisted ventilation + endotracheal intubation may be reuired in some cases)
83
what may cause pulmonary infection in surgical patients
collapse or aspiration
84
what is step 1 on the WHO analgesic ladder
non opioids and adjuvants e.g. aspirin, nsaids, paracetamol, selective COX-2 inhibitors
85
what is step 2 on the WHO analgesic ladder
mild opioids e.g. tramadol, cocodamol, codeine phsophate
86
what is step 3 on the WHO analgesic ladder
opioid ananlgesics - moprhine, fentanyl, (diamorphine, buprenorphine)
87
list some inhalational anaesthetics
halothane, nitrous oxide, enflurane, isoflurane, desflurane, sevoflurane
88
do you need a low or high blood:gas coefficient for rapid induction
low (more stays in blood rather than going back into lungs and being breathed out)
89
what are the two classes of muscle relaxants
depolarising and non-depolarising
90
list the main depolarising muscle relaxant used in anaesthesia
suxamethonium/succinylcholine
91
how does suxamtheonium/succinylcholine work
acts like acetylcholine by binding to AchRs, and causes AP's. However, it is broken down much more slowly and the following depolarisation lasts for an extended period. there is flaccid paralysis.
92
why is there initial muscle twitching with suxamethonium administration
when the sux binds to AchR's it causes initial depol and AP's, causing some initial twitching until paralysis ensues
93
list four drugs that are non-depolarising muscle relaxants
atracurium, mivacurium
| vecocuronium, pancuronium
94
how do non-depolarising muscle relaxants work
compete with ACh at the NMJ, preventing depolaritisation
95
how are muscle relaxants reversed
acetylcholinesterase inhibitors e.g. neostigmine to increase synaptic cleft ACh levels, hence compete with muscle relaxants bound to the receptors
96
what are some of the adverse effects of IV anaesthetics
irritant to veins/painful, respiratory/cardiovascular depression
97
which act more rapidly inhalational or iv anaesthetics, and why
iv - as they bypass the paradoxical excitement phase
98
list some iv anaesthetics
propofol, thiopental, etomidate
others: BZDs e.g. midazolam, diazepam
ketamine for short operations
99
what is the mechanism of action of propofol
potentiates GABA(A), but also Na channel blocker
100
list some of the analgesics used in anaesthesia
morphine, pethidine, diamorphine, codeine, tramadol, fentanyl/alfentanyl/remifentanyl, co-codamol
101
what is the mech of action of pethidine
like morphine - mu opioid receptor agonist
102
list some local anesthetics
lidocaine, bupivicaine, levobupivicaine
103
which has the shorter half life, lidocaine or bupivicaine
lidocaine
104
which of the muscle relaxant classes are longer acting
non-depolarising relaxants - though they have a slower onset of action
105
list the "premeds" used in anaesthesia
midaz, temaz, and ranitdine to reduce gastric acid secretion
106
list the drugs used in induction of anaesthesia
propofol, thiopental, etmidate, or inhaled anesthetics
107
what are the steps in rapid sequence induction of anaesthesia
1) preoxygenate
2) administer anaesthetic induction agent after some analgesia in vein
3) suxamethonium
4) wait for muscle fasciculations to cease
5) laryngoscopy + intubation with endotracheal tube
6) positioning of ET confirmed by presence of end-tidal CO2 trace, bilateral chest movements, auscultation
108
what are the steps in emergence of anaesthesia
1) administer 100% O2
2) reverse neuromuscular blockade with neostigmine etc
3) extubate only when patient is fully awake and able to remove the ET tube themselves
109
which agents may be used if bradycardia in emergence form anaesthesia
glycopyrolate or atropine
110
which part of the brain is triggered to cause N+V
chemoreceptor trigger zone
111
list the emergency drugs drawn up just in case for patients who go under anaesthesia, and what theyre for
- atropine for bradycardia
- ephedrine for hypotension
- suxamethonium for emergency reintubation
112
what are the symptoms of a massive pe
chest pain (pleuritic), SOB, pallor, shock
113
which agents are used for fibrinolysis in patients with a pe
streptokinase or urokinase iv infusion
114
in severe cases of pe, where fibrinolysis is not enough, what procudure can be carried out to remove the pe
embolectomy
115
what signs may indicate a wound infection
local erythema, tenderness, cellulitis, swelling, frank abscess, wound discharge, pyrexia, pulse increased
116
what is wound dehiscence
partial or complete breakdown
117
what is evisceration
extrusion of abdo viscera through complete abdo dehisence
118
what is the total body water volume
42L
119
what proportion of total body water in made up of ecf and icf
ecf - 1/3 (~14L)
| icf = 2/3 (~28L)
120
what proportion of ecf is made up of transcellular fluid, plasma, and interstitial fluid
interstitial + transcellular 4/5
| intravasc 1/5 (~3L)
121
what are the fluid requirements in adults
40ml/kg/24hr
122
what are the fluid requirements in children
first 10kg = 4ml/kg/hour
next 10kg = 2ml/kg/hour
remainder above 20kg = 1ml/kg/hour
123
what are the intracellular range for K+ and Na+
```
K+ = 133
Na+ = 9
```
124
what is the extracellular range for K+
3.5-5.5
125
what is the extracellular range for Na+
143
126
how is 5% dextrose distributed throughout the body fluid compartments, hence how much remains intravasc
it distributed throughout all body fluid compartments, hence 1/15 remains within the intravasc compartment (1/3 ecf x 1/5 intravasc). hence 1/15 of 1L bag
127
how is 0.9% saline fluid distributed throughout body fluid compartments
restricted by Na-K-ATPase on cell membrane, hence remains in extracellular compartment thus distributed thoughout ecf only. of the ecf, 1/5 if intravasc, hence 1/5 of 1L (200ml) remains intravasc
128
how are colloid fluids distributed throughout the body compartments
all remians intravasc (~100%) hence 1L of the 1L bag remains intravasc
129
how are fluid requirements calculated
maintencnace requirements + preexisting defiict + replace ongoing losses
130
list some sources of abnormal fluid loss
vomiting, diarrhoea, high output stoma, enterocutaneous fistula
131
which electrolytes is diarrhoea rich in
K+ and HCO3-
132
which electrolytes is vomitus rich in
H+, Cl-, K+
133
which antibodies and which antigens are expressed in group A blood
```
ag = A
ab = B
```
134
which antigens and antibodies are expressed in group B blood
```
ag = B
ab = A
```
135
which antigens and which antibodies are epxressed in group AB blood
```
ag = AB
ab = - (universal receiver)
```
136
which antigens and which antibodies are expressed in group O blood
```
ag = - (universal donor)
ab = AB
```
137
how many pints is one unit of blood, hence how many L
1 unit = 1 pint
| 1 pint ~450mls
138
how many pints/L of blood are there in the body
```
pints = ~10
L = 4.7-5.5
```
139
define a massive blood transfusion
transfer of 10 Units of blood (whole patient's circulating volume) in 24hrs
OR >50% of patient's blood volume (>5 Units) in 4 hours
in response to massive uncontrolled haemorrhage
140
list the things that are tested for in a patient pre-tranfusion
- blood group
- antibody screen
- x match (compatibility of patient's blood with donor)
141
what is the indication for blood transfusion
anaemia secondary to blood loss, Hb
142
up to what proportion of their circulating blood can a healthy adult lose before feeling any effects
30-40%
143
list some of the different components of blood that can be transfused into a patient
- red cells
- platelets
- FFP
- cryporeceiptate
- human albumin
- factor VIII/IX
- prothrombin complex concentrate (e.g. Beriplex)
144
what is FFP used for
multiple factor deficiency e.g severe bleeding or overcoagulation
145
what does crypoprecipitate contain and what is it used for
fibrinogen, factor VIII, VWF, factor XIII, fibronectin
| used when fibrinogen levels are low e.g. DIC
146
when is human albumin transfusion used
if vascular permeability is increased e.g. burns, oedema, or ascites resistant to treatment with diuretics
147
when is factor VIII/IX cocentrate used
Christmas disease/ haemophilia
148
when is prothombin complex concentrate used, and what does it contain
factors II, IX, X, VII (vit K dependent). to reverse the nticoag effects of warfarin when there is major bleeding
149
what checks are one when transfusing a patient with blood
- correct patient
- completed blood request form
double check identitiy of atient, abo and rhd type compatibility
- check donation number on pack, expiry, ensure no leaks/haemolysis
- vital signs before transfusion, during and after
150
list some acute reactions to blood transfusion
- acute haemolytic transfusion reaction
- TRALI
- febrile non haemolytic transfusion reaction
- allergic reaction
- sepsis due to bacterial contamination
- circulatory overload
151
why would acute haemolytic transfusion reaction occur
abo incompatibility
152
why would TRALI occur
Ab's in donor plasma react with recipient's leucocytes
153
why would febrile non-haemolytic transfusion reaction occur
neutrophil Ab in recipient plasma reacts with donor leucocytes
154
list some delayed transfusion reactions
- delayed haemolytic reaction
- allommunisation
- post transfusion purpura
- graft vs host disease
- transfusion-transmittted infections e.g. bbv, cmv
- iron overload (accumulation in tissues)
155
what is alloimmunisation in tranfusion of blood
ab are formed in response to donor antigens
156
why may post transfusion purpura occur
platelet specific antibodies attacking platelets
157
list three methods of autologous transfusion
- preop donation
- isovolaemic haemodilution
- cell salvage
158
how does preop donation work as autologous transfusion
patient's blood is collected prior to surgery and stored for up to 35days preop (usually only used for rare blood groups)
159
how does isovolaemic haemodilution work
blood drawn preop and put in bag with anticoag + saline, and reinfused during surgery/post op (where significant blood loss is anticipated)
160
what is cell salvage
blood collected form op site, processed by machine, anticoagulated, cells washed from clots and debris. returned to patient
161
when is cell salvage contraindicated
malignancy, sepsis
162
what are the good things and downsides to cell salvage
```
good = reduced exposure to allogenic blood
bad = not haemodyanmically intact due to consumption of clotting factors
```
163
list three reasons why direct arterial pressure monitoring may be carried out
- failure of indirect monitoring
- arterial blood sampling
- continuous reactive monitoring
164
what is a possible complication of direct arterial monitoring
distal ischaemia
165
list some of the complications of arterial catheter placement
arterial puncture, haematoma, haemothorax, nerve injury, pneumothorax, air embolism, sepsis, endocarditis, venous thrombosis, pe, cardiac tampomade
166
what is prothrombin time a measure of
for those on warfarin (like inr), extrinsic factors VII, V, X, prothrombin and fibrinogen
167
what des prolonged prothrombin time indicate
deficiency in one or more of the factors tested for - can mean there is a vit k deficiency, or liver disease
168
what does aptt measure
used for patients on heparin to measure intrinsic system factors e.g. XII, XI, VII, IX
169
what does increased aptt mean
deficiency in clotting factors tested for, liver disease, bleeding disorder etc
170
what is the mechanism of action of warfarin
inhibits vitamin K - dependent synthesis of biologically-active forms of clotting factors II, VII, IX and X, as well as protein C and S. inhibits reduction of vitamin k
171
what is the mechanism of action of unfractionated heparin
works by binding to antithrombin III, thrombin and factor Xa
172
what is the mechanism of action of lmwh
binds to ATIII and factor Xa (NOT thrombin)
173
what is ASA I
normal healthy patient
174
what is ASA II
patient with mild systemic disease, and no functional limitations
175
what is ASA III
patient with moderate or severe systemic disease, that results in some functional limitation
176
what is ASA IV
patient with severe systemic disease that is a constant threat to life and functionally incapacitating
177
what is ASA V
moribund patient, who is not expected to survive 24 hours without surgery
178
how many days before surgery must clopidogrel be stopped
7
179
where does haemopoeisis occur in the first few weeks
yolk sac
180
where does haemopoeisis occur in the next few months of life
liver and spleen
181
where does haemopoeisis occur after 6-7months after conception
bone marrow
182
what are the two main cell lines from whcih blood components arise
common myeloid and common lymphoid
183
why may extramedullary haemopoeisis occur
failure of bone marrow to produce blood cells
184
which factor is important in B12 absorption
intrinsic factor
185
why do red blood cells require folate and vit B12
to progress through mitosis
186
except for rbc changes, what other blood cellsdoes vit b12 and folate deficiency cause
giant hypersegmented neutrophils
187
which drug s given to chelate iron in those with sickle cell disease
hydroxycarbamide
188
what is the difference between alpha and beta thalassaemia
alpha thalassameia is caused by alpha genes missing/inactive wherease beta is caused by beta genes missing/inactive
189
what do rbc's look like in vit b12 deficiency
large, oval shaped
190
which bbvs can cause immune destruction of platelets
hiv, hep
191
give some common causes of microcytic anaemia
thalassaemia, anaemia of chronic disease, iron deficiency
192
Which INR level is acceptable for surgery
Less than 2.5
193
What is sick sinus syndorme
Sinus node dysfunction which causes one of two things
- tachy Brady syndrome
- Brady +/- arrest
194
How you manage a patient with sick sinus syndrome
Pacing
195
How may you be able to control ventricular rate in atrial fibrillation/flutter
Digoxin loading dose followed by maintenance
196
What is an avnrt (AVN ree try tachy)
Ree try circuit within or just next to the AVN
197
Which arrhythmia is avrt commonly associated with
Wpw syndrome
198
What is avrt (av reentry tachy)
Accessory pathways occurs between the atria and ventricles allowing electrical signal to pass from ventricles back to atria and cause premature contraction. This occurs alongside the normal AVN pathway, where depolarisation goes down heart normally and back up into atria through accessory pathway - loop. Creates a complete re entrant tachy
199
What is wpw syndrome
Individuals have an accessory pathway that doesn't share the rate slowing properties of the AVN (bypasses this) - hence electrical activity is conducted at a higher rate
Retrograde or anterograde
Type of preexcitation syndrome
200
List the differentials for narrow complex tachycardia
```
Sinus tachy
SVT
AF
Atrial flutter
Junctional tachy
```
201
List the differentials for broad complex tachy
Vt, incliding torsades de pointes
| SVT with aberrant conduction
202
What is a capture beat
Normal qrs between abnormal beats
203
What is a fusion beat
Normal beat fuses with vt complex
204
List the different types of junctional tachy
- avrt
- avnrt
- his bundle tachy
205
What drug do you initially give to someone with a junctional tachy
Adenosine
206
What is carcinoid syndrome
Array of symptoms that occur secondary to carcinoid tumours. Includes flushing, diarrhoea, and less frequently heart failure and bronchoconstriction
Caused by endogenous secretion of serotonin and kallikrein
207
What is a rock all score used to calculate
Risk of death in a patient with an acute upper gi bleed
208
List the parameters involved in calculating a rockall score
- age
- shock/haemodynamic instability
- comorbidities e.g. Ihd, liver/kidney disease
- diagnosis, Malory Weiss, upper gi ca, any other
- avoidance of belled ding on ogd
209
What is the blatchford score
In gi bleeds, used to assess if patients can be managed out of hospital or need to be in a hospital setting
