Author: Jidhin Davis, Dhavapalani Alagappan, Madhumita Subramony / Editor: Yasmin Sultan / Codes: GP8, HP3, RP7, SLO3, SuP5Published: 08/02/2023

A 41-year-old man, known to have Von Willebrand disease type III (absent Von Willebrand Factor), is brought to the Emergency Department (ED) with rectal bleeding. He had a polypectomy 10 days prior. Biopsy showed an adenomatous polyp with low grade dysplasia.

The patient presents with complaints of bleeding per rectum, bright red in colour, associated with giddiness. Paramedics find the patient to have HR-140/min, BP of 60/40mmHg. A large bore IV cannula is placed and 1000ml Ringer Lactate bolus is given prehospital.

On arrival at the ED, his observations are:

HR-120/min, BP-70/40mmHg, Spo2-98% on 10L of O2 in RA, RR-20/min and CBG-9.1mmol/L.

  1. Airway patent
  2. B/L air entry equal, no added sounds
  3. Peripheries cold, distal pulses rapid and thready.
  4. Drowsy but arousable. No focal neurological deficits.
  5. Per abdomen soft, non-tender, undergarments stained with blood.

Arterial Blood Gas: pH-7.10, pco2-32, po2-85, Hco3-10, BE: -12, lac -4.6.