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Occult scaphoid fracture — RCPSC EM MCQ

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HardMusculoskeletalOccult scaphoid fractureRCPSC EM

A patient with cirrhosis has ongoing large-volume haematemesis, hypotension and declining consciousness. What is the most appropriate initial resuscitation priority?

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Correct answer: B — Establish large-bore access and resuscitate before definitive airway intervention

The best answer is “Establish large-bore access and resuscitate before definitive airway intervention”. Massive upper GI bleeding requires resuscitation based on clinical shock rather than a single hemoglobin result. Establish access, provide hemostatic resuscitation and preoxygenate while coordinating ICU, GI and surgical or interventional support; airway management follows a deliberate resuscitative plan. Acid suppression or vasoactive medication may be adjuncts but cannot replace circulation and airway preparation.

Reference: Emergency Care BC: Massive GI Bleeds: https://emergencycarebc.ca/clinical_resource/clinical-summary/massive-gi-bleeds/