- 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
- 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
upperGIT/visiblevessel
The score for metastasis liver is 3.
A score of more than 6 is said to be an indication for surgery