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Upper gastrointestinal bleeding with shock — SCE Acute Medicine MCQ

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EasyAcute GI PresentationsUpper gastrointestinal bleeding with shockSCE Acute Medicine

A 69-year-old man is assessed on the acute medical unit. He has haematemesis and melaena with systolic blood pressure 78 mmHg. He is clammy and haemoglobin has fallen from 132 to 82 g/L. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: A — Activate the major haemorrhage protocol

Activate the major haemorrhage protocol is the best answer because haemodynamic instability from GI bleeding requires immediate resuscitation, blood products and senior involvement. Perform needle decompression followed by chest drain insertion is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Endoscopy follows resuscitation; it is not the first action in shock.

Reference: NICE CG141