Case 1
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Question 1 of 3
1. Question
A 50-year-old man is brought into the emergency department with a history of six episodes of fresh PR bleeding in the last four hours.
He denies any vomiting or haematemesis but explains that he had some chest pain earlier in the evening. On examination he is disorientated and clammy.
Initial observations show that his HR is 140 bpm, blood pressure 60/40mmHg and Sats 95% on room air.
What are the five initial actions and priorities in this case?
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Question 2 of 3
2. Question
Which of the following features suggest a patient to be high risk and may prompt admission?
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Question 3 of 3
3. Question
The patient undergoes colonoscopy which fails to identify the lesion. Subsequent angiography shows an angiodysplastic lesion and the patient receives a vasopressin infusion with cessation of bleeding. The patient is transferred to a high dependency area.
The following day, there is ongoing fresh PR bleeding and the patient has a blood pressure of 70/40mmHg despite aggressive resucitation.
What are the three most appropriate steps in the ongoing management of this patient?
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