To determine if the patient requires admission or can be discharged, the Glasgow-Blatchford Score (GBS) is used.

Here’s the ABCDEF mnemonic and why these factors increase the risk of an upper GI bleed:

• ​ A - Active: Conditions like syncope or melena indicate ongoing or significant bleeding, increasing risk severity.

• ​ B - Blood Urea Nitrogen: Levels ≥ 7 mg/dL suggest impaired kidney function, which is often associated with poor systemic clearance and bleeding risk.

• ​ C - Circulation: A systolic blood pressure ≥ 110 mm Hg may reflect hemodynamic instability or stress response to bleeding.

• ​ D - Drop in Hemoglobin: Hemoglobin levels ≤ 12.9 g/dL (men) or ≤ 11.9 g/dL (women) indicate anemia, suggesting significant blood loss.

• ​ E - Elevated Pulse: A pulse rate ≥ 100/min signals compensatory tachycardia, often a response to blood loss.

• ​ F - Failure: Cardiovascular or liver disease impairs clotting and hemodynamic stability, exacerbating bleed risk.

Developed in Scotland, the GBS is a risk assessment tool for upper GI bleeds and considers symptoms, vital signs, and lab values on admission. Key factors in the score include melena, syncope, liver disease, heart failure, heart rate, blood pressure, hemoglobin, and BUN levels. Points are assigned based on these variables to assess the severity of bleeding and volume loss.

For example:

• ​Melena suggests significant GI bleeding, whereas isolated hematemesis (like coffee-ground emesis) has no scoring points.
• ​Syncope, tachycardia, hypotension, and changes in Hb/BUN levels suggest volume loss.
• ​Comorbid conditions (e.g., liver disease) may indicate a need for admission, especially if variceal bleeding is suspected.

Discharge criteria also include access to follow-up care, a support system, and a nearby hospital for emergency returns if symptoms worsen.

For more on current recommendations, consult the 2021 American Journal of Gastroenterology guidelines on upper GI bleeding.

CENTOR criteria Fever PAIN: Strep Throat mnemonic

The “H’s and T’s” refer to a mnemonic used in medicine to help healthcare professionals quickly recall the most common causes of cardiac arrest during a code (a medical emergency requiring CPR). Memorizing these is crucial because identifying and addressing these causes rapidly can improve the chances of saving a patient’s life.

Here’s a breakdown:

The H’s: OK TV

Hypoxia - Lack of oxygen to tissues can lead to a heart stopping, so ensuring proper oxygenation is key.

Hypo-/Hyperkalemia - Abnormal potassium levels affect the heart’s electrical activity, potentially causing it to stop.

Hypothermia - Low body temperature can slow heart function and lead to cardiac arrest.

Hypovolemia - Loss of blood or fluids can lead to insufficient circulation and cardiac arrest.

Hydrogen ion (acidosis) - A build-up of acid in the blood (often due to respiratory failure or shock) can disrupt heart function.

The T’s: THROW TEN TOXIC TAMPONS

Thrombosis (pulmonary or coronary) - Blood clots in the lungs (pulmonary embolism) or heart (myocardial infarction) can obstruct blood flow, leading to cardiac arrest.

Tension Pneumothorax - Air trapped in the chest cavity compresses the heart and lungs, affecting circulation.

Toxins - Certain substances (medications, drugs, poisons) can disrupt heart rhythms.

Tamponade (cardiac) - Accumulation of fluid around the heart prevents it from pumping effectively.

Importance of Memorizing the H’s and T’s:

These causes cover many reversible conditions that may lead to cardiac arrest. During a code, time is critical, so having these potential causes at the top of your mind helps quickly assess and treat the patient. Remembering the “H’s and T’s” mnemonic ensures that a healthcare provider methodically works through possible causes and provides the best chance of resuscitation.