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Massive upper gastrointestinal bleeding — ACEM Fellowship MCQ

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HardGI/Abdominal emergenciesMassive upper gastrointestinal bleedingACEM Fellowship

A 61-year-old man with cirrhosis presents to a Sydney ED, triage category 1, vomiting fresh blood. BP 72/38, HR 138, GCS 13. Hb is 68 g/L, INR 2.0 and lactate is 6.0. He has ongoing haematemesis in resus. What is the most important immediate action?

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Correct answer: A — Activate massive transfusion and airway-ready resuscitation

Shock with ongoing haematemesis requires airway-aware resuscitation and massive transfusion before definitive endoscopy.

Reference: ACEM resuscitation curriculum; eTG upper GI bleeding