What initial assessments should I perform for a patient presenting with haematemesis or melaena?

Initial assessments for a patient presenting with haematemesis or melaena include:

• Perform a formal risk assessment using the Blatchford score at first assessment to stratify risk and guide management decisions.
• Assess haemodynamic stability by measuring vital signs such as blood pressure and heart rate to identify signs of shock or massive bleeding.
• Evaluate the need for blood transfusion based on the clinical picture, including the severity of bleeding and haemodynamic parameters, avoiding over-transfusion.
• Check platelet count and coagulation status (prothrombin time/INR, activated partial thromboplastin time) to identify coagulopathy and guide transfusion of platelets, fresh frozen plasma, or prothrombin complex concentrate if the patient is actively bleeding.
• Consider the patient’s medication history, especially anticoagulants like warfarin or direct oral anticoagulants, and plan reversal if necessary.
• Initiate resuscitation promptly in unstable patients, including blood product transfusion according to local massive bleeding protocols.
• Plan for early endoscopy: immediately after resuscitation in unstable patients or within 24 hours for others.

These assessments ensure timely identification of severity, guide resuscitation, and facilitate appropriate specialist referral and intervention.

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