Vomiting blood in the emergency department
PLAB 2 practice station

The task

You are a doctor in the emergency department. Mr Terence Gill, aged 61, has been brought in by his wife after vomiting bright red blood at home. He is on a trolley in the resuscitation area and his wife is in the relatives' room. A nurse has attached monitoring and will carry out your requests. Assess and manage him, then explain what you plan to do and why. The examiner will give you any findings you ask for. The examiner will not take part in the conversation.

What this station tests

• Resuscitate first with ABCDE: two large-bore cannulae, bloods, group and crossmatch, fluids, and blood if needed.
• Stop NSAIDs. Arrange endoscopy immediately after resuscitation if unstable, otherwise within 24 hours. Do not give acid-suppressing drugs before endoscopy for a suspected non-variceal bleed.
• Consider varices in heavy drinkers; look for signs of liver disease.
• Use a risk score such as Glasgow-Blatchford to decide who can be managed as an outpatient.
• Involve a senior early, and call 2222 if he collapses.

Sources for the clinical content

• NICE CG141: Acute upper gastrointestinal bleeding in over 16s: management
• Resuscitation Council UK: The ABCDE approach
• NICE CG100: Alcohol-use disorders: diagnosis and management of physical complications

An original practice scenario with invented patients. Not an exam question.

Practise next

• Unwell ward patient with a rising early warning score
• Sudden breathlessness and itching after an infusion
• Wheezy and breathless young woman
• Confused and sweaty patient on the ward