You note there is a patient reporting new black stools who is on warfarin and has a dropping Hb and rising urea.
You remember the most common type of bleeding in a patient on anticoagulants is GI bleeding.
“Er, shouldn’t you speak to gastro? Seems like he’s having a GI bleed.”
You hear a dial tone. It’s the tone of delayed realisation.
You transform into the gastro SHO because you are just so helpful.
When you see the patient, he is slightly sweaty. He is lying flat because he feels faint when he is upright. His pulse is now 122, with a blood pressure of 98/66 mmHg. He complains of ongoing “indigestion” pain for the past two days.
He then vomits coffee ground vomit in front of you.
You start IV Saline 0.9% stat through a wide bore cannula and plan to reassess the response. You arrange FBC, U&E and coagulation. You delegate sorting out warfarin reversal to the FY1 who is with you.
What do you do next?
Include group and save on the bloods, plus urgent plain abdominal xray
Include crossmatch four-six units of packed RBCs on the bloods, plus a VBG