61-year-old male is brought into Resus by paramedics with a history of 3 episodes of fresh haematemesis over the preceding 3 hours. No abdominal pain or melaena.
— PMH: Alcohol dependence, Chronic Liver Disease


A – Clear & self maintaining.

B – Rate 25, SpO2 98%. Room air.

C – Pulse 130, BP 87/60.

D – E4 V5 M6 pupils equal

E – Temp 36.9°C

Clinical Findings

  • Cold, sweaty and pale

  • Fresh blood visible around mouth and lips

Why We Simulated

Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has not significantly improved over the past 50 years.

Learning Points

  1. Use local proformas where available - they provide useful prompts when assessing severity and initiating treatment

  2. In patients presenting with Upper GI Bleeds consider recruitment to Halt-It trial

  3. If a patient is bleeding and haemodynamically unstable despite appropriate resuscitation activate Massive Haemorrhage protocol


Positive Feedback

  • Good preparation pre-arrival, clear allocation of roles within team

  • Recognised massive GI bleed and resuscitated with blood

  • Early institution of variceal bleed care bundle
Edit & Peer Review by Jamie Sillett