Author: Lily Stanley, Tom Roberts / Editor: Mark Winstanley / Reviewer: Lily Stanley / Codes: GP1, HP3, RP7, SLO3, SuC15, SuP1 / Published: 08/07/2021

A 22-year-old man with a history of Asperger’s Syndrome but otherwise fit and well, presented to the Emergency Department (ED) following a collapse. 

An ambulance was called when he collapsed on standing from the sofa after a 24 hour history of vague abdominal pain (but no history of trauma). Paramedics found him to be hypotensive, BP 50 systolic, tachycardic and GCS 14/15. The crew pre-alerted the ED that they had a young male with abdominal pain and profound hypotension. Differentials considered at this time were DKA and an acute abdomen secondary to perforated viscus. 

On arrival to the ED, he was pale, confused and complaining of severe abdominal pain. IV access was gained and a venous blood gas revealed a haemoglobin of 45g/L. His abdomen was distended and tender with absent bowel sounds. 

The Major Haemorrhage Protocol was activated and resuscitation was initiated and continued whilst diagnostic imaging was arranged.