Question

A 64-year-old man with a history of heavy alcohol use presents with large-volume haematemesis and melena. He is pale and diaphoretic with blood pressure 85/50 mm Hg and heart rate 120 beats/min. What is the most appropriate immediate management step in the emergency department?

Accepted Answer

Secure two large-bore intravenous lines and begin rapid isotonic crystalloid resuscitation, crossmatch blood and call for urgent endoscopy.

Answer

Arrange urgent upper endoscopy without further resuscitation.

Answer

Administer high-dose intravenous proton pump inhibitor after haemodynamic stabilisation.

Answer

Give oral omeprazole and plan outpatient endoscopy.

Answer

Position the patient upright and observe to see if bleeding stops spontaneously.

Practice question

A 64-year-old man with a history of heavy alcohol use presents with large-volume haematemesis and melena. He is pale and diaphoretic with blood pressure 85/50 mm Hg and heart rate 120 beats/min. What is the most appropriate immediate management step in the emergency department?