Haematemesis is the vomiting of blood, either bright or altered blood (so-called 'coffee grounds' vomitus), due to the action of acid on the blood.
History important to establish cause (known ulcers, anticoagulant/ steroid/NSAID’s use, alcoholic,
history of varices) & amount of bleeding etc.
Look for features of shock, chronic liver disease, encephalopathy & don’t forget to do PR.
1. ABC’s Resuscitation as indicated,
3. Continuous monitoring,
4. IV access, 2 x large bore cannulae if shocked,
5. Fluid resuscitation with Hartmann’s/ packed cells/ FFP as indicated,
6. FBC, U&E’s, Coag. Profile, Cross-match packed cells as considered appropriate (2-4
9. NGT if profuse haemorrhage,
10. Cathterise to monitor urine output,
11. Consider central line & ionotropes if unstable,
12. IV Pantoprazole 40 mg stat,
13. If suspected varices:
· Octeratide infusion (500 mcg in 100 ml N.Saline) 50mcg bolus followed by 50mcg/hr for 24 hours,
· Sangstaken tube, or
· Vasopressin infusion (0.2-0.4 units/min).
Liaise early with medical officer/Surgeon regarding treatment, endoscopy & disposition