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Major haemorrhage and massive transfusion — SCE Acute Medicine MCQ

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ModerateCritical Care MedicineMajor haemorrhage and massive transfusionSCE Acute Medicine

A 58-year-old man on apixaban presents with haematemesis and shock. Blood pressure is 74/42 mmHg, pulse 132/min and haemoglobin is 68 g/L. Two large-bore cannulae are in place and urgent endoscopy is being arranged. What is the most important immediate action?

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Correct answer: E — Activate the major haemorrhage protocol

Shock from major GI bleeding requires immediate activation of the major haemorrhage protocol to deliver balanced resuscitation, blood products and coordinated support. Waiting for crossmatched blood may be unsafe when exsanguination is possible; emergency group O blood may be needed. Vitamin K does not reverse apixaban. The pearl is that process activation is a clinical intervention in major haemorrhage.

Reference: BSH major haemorrhage guidance; NICE CG141