29th February 2024

A 63-year-old gentleman is brought to the emergency department following a collapse at home.

A 63-year-old gentleman is brought to the emergency department following a collapse at home.

The ambulance crew report evidence of coffee-ground vomit at the scene.

PM. Alcoholic liver disease. DH. Spironolactone 200mg PO daily. NKDA. SH. Drinks 8 bottles of wine per week.

On examination

Patient is alert but drowsy on initial assessment. A Bair Hugger™ device and non-rebreather oxygen mask are both in-situ. His clothing appears to be stained by dark vomit.

Temperature 36.1, HR 156/min and rhythm regular, BP 72/44 mmHg, RR 28/min, O2 sat 96% on air

Weight 63kg

Investigations

Hb 66 (130 – 180 g/L)

Na+ 128 (133–146 mmol/L)

K+ 3.3 (3.5–5.3 mmol/L)

Ca2+(adjusted) 2.3 (2.2-2.6 mmol/L)

Mg2+ 0.6 (0.7–1.0 mmol/L)

Chloride 102 (98-106 mmol/L)

Phosphate 0.72 (0.74 – 1.4 mmol/L)

Urea 44 (2.5 – 7.8 mmol/L)

Creatinine 134 (59 – 104 μmol/L)

Lactate 3.2 (0.5 – 2.2 mmol/L)

Cross-match result pending

He is given a bolus of warmed Hartmann’s 500ml IV over 10 minutes, and the Major Haemorrhage Protocol (MHP) has been activated with O-negative blood products en route.

Please select the most appropriate additional management at this stage