Haemodynamic Instability

If there is evidence of haemodynamic instability; tachycardia (but remember elderly or those on beta blockers may not mount a tachycardia), widened pulse pressure, tachypnoea, or hypotension (which may be a late sign particularly in younger patients) – involve senior EM staff early and begin resuscitation following the ABC approach.

• High concentration oxygen via non-rebreather mask with reservoir bag
• Two large bore peripheral intravenous cannulae (if access is difficult consider US guided or IO access)
• Bloods (see investigations)
• Transfuse according to local protocols and consider activating major haemorrhage protocols early
• Urinary catheter to measure urine output
• Urgent referral to GI service or surgery (depending on access to endoscopy and in-hours/out-of-hours – check your local policy!)
• Involve critical care team