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.