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Assessment of severity of blood loss

  • 500 ml loss- No systemic signs except in elderly and anaemic patients
  • 1000 ml (20% reduction of blood volume) -characterised by tachycardia, orthostatic hypotension, syncope, light headedncss. nausea, sweating and thirst
  • 2000 ml or more(40% reduction of blood volume) – there will be profound shock and possibly death
  • Drop in urine output < 0.5 ml/kg/hr indicates moderate to marked hypovolaemia.
  • Early sign of cessation of bleeding and restoration of blood volume is return of the normal heart rate
What is Tilt Test
  • Tilting the head end of the body upwards at an angle of 75° for 3 minutes will leads to accelerated heart rate and a drop in systolic blood pressure
  • Increase in heart rate of < 20 beats/min and absence of light headedness, indicates slight or compensated blood loss
  • Increase in heart rate of > 30 beats/min and presence of faintness or syncope indicates decompensated blood loss and need for restorative measures.

Rockall Risk Scoring System for Gl bleeds
Score                            0                                1                                           2
Age                                 <60 yr                         >60-79 yr                          80 years and above
Systolic BP                     > 100 mm of H          >100 mm of Hg                  <100mm of Hg
Pulse rate                        < 100/mi                    >100/min
Co-morbidity Diagnosis   No                    IHD/cardiac failure                 Renal /liver failure       
                                    Mallory Weiss tear,           All other diagnosis                  Upper GI malignancy
                                    no lesions or signs 
                                    of recent bleed
Endoscopic evidence 
of recent haemorrhage None/dark red spot                                               Adherent clot/blood in 
The score for metastasis liver is 3.
A score of more than 6 is said to be an indication for surgery