Haematemesis

Question 1

A 25 year old man presents with haematemesis after binge drinking. How would you assess and manage him?

Answer 1

Impression
Upper GI bleed given significant haematemesis. Given the patients recent alcoholic binge. Key differential causes to consider include;
- Mallory-weiss tear (usually hx of chronic coughing) - usually small Hb
- Oesophageal varices rupture (usually more chronic alcoholism history) - usually MASSIVE Hb

Question 2

Haematemesis - Assessment

Answer 2

Assessment
Would first call for senior help and begin a primary assessment of the patient, given potential for significant blood loss and complications of hypovolaemia including shock.
A - patent, maintaining - blood-filled, threatened: suction for blood, utilise any respiratory adjuncts, positioning upright: would need to institute protective measures
B - RR, SP02, likely intact but may become compromised with hypovolaemia/aspiration - would need to
C - BP monitoring and HR. 2xIVC, ECG, CBG, G+xmatch, etc. Would consider starting fluid resuscitation if HD unstable, ultimately want to replace like for like so consider activating MTP if significant blood loss.
Rest of primary assessment as per normal.

Question 3

Haematemesis - History and Examination

Answer 3

History

• take collateral Hx if unable to communicate
• time of onset, ?volume lost,
• sx:

Exam

• Primary survey as above
• assess vitals for HD stability