Identify Haemodynamic Instability

If there is any evidence of haemodynamic instability then involve a senioremergency department physician and institute the following resuscitative steps:

  • High concentration oxygen delivered via a variable deliver mask with reservoir bag
  • Two large bore peripheral intravenous cannulae
  • Bloods (see investigations)
  • Large IV access should be obtained urgently
  • Consider if major haemorrhage protocol needs to be activated if hemodynamically unstable and visibly excessive blood loss PR.
  • Following your local blood transfusion protocol should result in appropriate amounts of RBC, FFP and plasma.
  • Increments of fluids and blood products dependent on patients age, estimated blood loss, and blood availability should be used to maintain adequate vital signs [14,15]
  • Gastric tube and aspirate stomach if in doubt about the upper GI source
  • Urinary catheter and measure urine volumes
  • Urgent referral to senior surgeon and critical care if instability persists

Learning bite

Prompt resuscitation and early involvement of surgical team are vital.