Question

A 65-year-old man presents to the emergency department with large-volume haematemesis and melena. He is pale, diaphoretic and hypotensive with blood pressure 86/50 mm Hg and heart rate 120 beats per minute. What is the most important immediate management step?

Accepted Answer

Begin aggressive intravenous crystalloid resuscitation and blood transfusion as indicated.

Answer

Arrange urgent upper endoscopy within 24 hours without resuscitation.

Answer

Start high-dose oral proton pump inhibitor and discharge.

Answer

Start prophylactic low-molecular-weight heparin to prevent venous thrombosis.

Answer

Order immediate CT angiography to localise bleeding before resuscitation.

Practice question

A 65-year-old man presents to the emergency department with large-volume haematemesis and melena. He is pale, diaphoretic and hypotensive with blood pressure 86/50 mm Hg and heart rate 120 beats per minute. What is the most important immediate management step?