You call the radiologist on call.

“Hi, I’d like to request an urgent CT Abdo.”

“Why?”

“A 56 year old man with abdominal pain and with a dropping Hb. I think he’s having an upper GI bleed.”

“Doesn’t he need a scope?”

“…”

“…”

“That would also work”

You hang up the phone sheepishly.

The nurse informs you his observations are now pulse 115 and blood pressure 105/74 mmHg. The FBC returns an Hb of 69 g/L and there is an INR of 4.1. Your FY1 reassures you he is reversing the warfarin using vitamin K.

You wonder if there’s anything you should do before getting an endoscope.

Use prothrombin complex concentrate for warfarin reversal. Crossmatch four units and transfuse until haemodynamically stable, maintain Hb > 70 g/L, continue fluids until then

Continue with vitamin K for warfarin reversal. Group and save four units and transfuse (as group and save is quicker than crossmatch) until haemodynamically stable, maintain Hb > 70 g/L, continue fluids until then

Continue with vitamin K for warfarin reversal. Emergency unmatched O negative blood and transfuse until haemodynamically stable, maintain Hb > 90g/L, continue fluids until then.