MedBugs: SAQ #34

Case: Melaena

A 76-year-old woman has been brought in from home with melaena. She has a background of hypertension, ischaemic heart disease and atrial fibrillation for which she is anticoagulated with dabigatran 110mg BD. Her vitals are : T 36.2˚C HR 140 irregular BP 95/50 RR 24 Sats 97%RA GCS 14 BSL 8 Bloods have been performed and are shown below :

Test	Result	Normal values
Hb	86	130–170 g/L
Platelets	150	150–400 ×10⁹/L
INR	1.6	0.9–1.2
Urea	25	4.5–10 mmol/L
Creatinine	120	60–100 micromol/L
Albumin	28	33–48 g/L

1. List (6) causes for upper gastrointestinal bleeding. 6 marks

2. Complete the table below, listing (4) medications that may be prescribed for this patient in the emergency department and a rationale for each. 8 marks

3. List (2) indications for blood transfusion in this patient. 2 marks

4. What was the outcome of the HALT-IT trial? 1 mark

5. Using the AIMS65 scoring system, what it this patient’s mortality risk? 1 mark

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Case: Melaena

1. List (6) causes for upper gastrointestinal bleeding. 6 marks

2. Complete the table below, listing (4) medications that may be prescribed for this patient in the emergency department and a rationale for each. 8 marks

3. List (2) indications for blood transfusion in this patient. 2 marks

4. What was the outcome of the HALT-IT trial? 1 mark

5. Using the AIMS65 scoring system, what it this patient’s mortality risk? 1 mark

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