Massive haematemesis — 65M, Korle Bu 02:00

Setting

You are the surgical registrar on-call at Korle Bu. It is 02:00. Endoscopy is available on-call within 90 minutes; blood bank has O-negative on the floor; anaesthesia and theatre are activated on request.

Patient

Mr K, a 65-year-old carpenter, is brought in having vomited large volumes of fresh red blood twice and passed black tarry stool three times over the last four hours. He is on daily aspirin and ibuprofen for back pain. He drinks a beer or two after work. Vitals: BP 92/58, HR 128, cool peripheries, GCS 15. No ascites, no jaundice, no stigmata of chronic liver disease.

Reference stack

Bailey & Love 28e Ch 65 · Sabiston 21e Ch 47 · SIGN 105 · NICE CG141 · Baveno VII (variceal 2022) · Forrest 1974 · Glasgow-Blatchford 2000