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Acute variceal haemorrhage — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute variceal haemorrhageRCPSC EM

A 55-year-old man with cirrhosis vomits large volumes of blood. Blood pressure is 92/54 mmHg, heart rate is 122/min and haemoglobin is 79 g/L. He has ascites and scleral icterus. Two large-bore IVs are placed. What is the most appropriate next step?

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Correct answer: D — Initiate balanced transfusion as needed, give ceftriaxone and octreotide, and arrange urgent endoscopy

Suspected variceal haemorrhage requires resuscitation, restrictive transfusion strategy where appropriate, vasoactive therapy, prophylactic antibiotics and urgent endoscopy after stabilisation.

Reference: Canadian Association for the Study of the Liver guidance; Rosen's Emergency Medicine