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
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