Resuscitation

In patients who are critically unwell, resuscitation is warranted. Signs of haemodynamic instability should be looked for, such as tachycardia (though the elderly, or those on beta-blockers may not mount this response), widened pulse pressure, tachypnoea, or hypotension.

Involve senior emergency medicine colleagues early and begin resuscitation using an ABC approach.

• High concentration oxygen via non-rebreather mask
• Large bore peripheral IV access consider intraosseous if access is difficult
• Transfusion according to local protocols, consider activation of the major haemorrhage pathway
• Urinary catheter to measure output
• Urgent referral to your endoscopy service know your local policy!
• Consider involving the critical care team particularly if haemodynamic instability persists despite adequate resuscitation.