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Failed airway with contaminated upper GI bleed — RCPSC EM MCQ

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HardResuscitation, procedures, airwayFailed airway with contaminated upper GI bleedRCPSC EM

A patient with ongoing massive hematemesis has BP 68/38 mmHg and requires airway control. The massive transfusion pack and intubation team are present. What should occur first?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Begin blood-product resuscitation and improve hemodynamics before drug-assisted intubation

Explanation lettering: E = shown as A · D = shown as B · B = shown as C · C = shown as D · A = shown as E

C is correct because induction in profound hemorrhagic shock can cause arrest; resuscitation should precede intubation when both can be mobilized rapidly. D exposes the patient to peri-intubation collapse. E provides adjuncts rather than circulation. A and B postpone both stabilization and definitive sequencing.

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