Unconscious Patient, Haematemasis & Melaena [Case #2]

“A 59 year old man is brought into the assessment bay, he is vomiting fresh red blood and has a brought a bowl full of it. You notice he looks a little jaundiced.”

He is alert with a normal respiratory rate and SATS. His heart rate is 120, BP 89/45 and he is clammy. From the front of his notes you can see he has previously presented with chest pain and an MI.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case.

1. What are your management priorities?

2. What is his pre-endoscopy rockall score?

3. You suspect a variceal bleed, how does this alter your management?

4. At what point would you consider using blood products?

5. The bleeding continues and a medical student asks if you would consider a sengstaken tube. What would you explain to the student about the use of such devices?

6. How many risk factors for upper GI bleeding can you recall?