23rd July 2023

You attend a medical emergency call for a suspected variceal haemorrhage

You attend a medical emergency call for a suspected variceal haemorrhage.

The patient is seen on the acute medical unit, having been admitted the day before with abdominal distension. He has a known history of alcohol-related liver disease with cirrhosis. The nursing staff report he has not had any history of collapse or melaena.

You carry out an ABCDE assessment and find the following:

A – patent

B – respiratory rate 22/min, SpO2 91% on room air, bilateral, equal air entry with no added sounds

C – heart rate 124 bpm, capillary refill time 4s, blood pressure 92/55 mmHg, heart sounds are dual with no added sounds

D – alert, glucose 5.4 mmol/L, pupils are equal and reactive to light

E – temperature 36.6°C, abdomen is distended but soft with active bowel sounds

You obtain vascular access with two wide-bore cannulae and send off a full set of bloods, including a group and save and a venous blood gas. The following blood results are obtained:

• Haemoglobin 82 g/L (130-180 g/L)
• White cell count 13.2 x 10⁹L (3.6 – 11.0 x 10⁹/L)
• Urea 8.6 mmol/L (2.5-7.8mmol/L)
• Creatinine 92 μmol/L (59-104 μmol/L)

The medical registrar asks you to contact the on-call gastroenterologist.

What is this patient’s Blatchford score?

Select the SINGLE most appropriate option from the list below. Select ONE option only.