A fictional 58-year-old presents after vomiting blood, with dizziness on standing and a history of chronic liver disease.
Frame the danger first.
- Assess the haemodynamic effect of bleeding rather than relying on the first haemoglobin result.
- Look for features of portal hypertension, coagulopathy and relevant medicines.
- Use an appropriate risk score as part of—not instead of—clinical assessment.
Act, escalate, reassess.
- Resuscitate using an ABCDE approach, obtain access and activate the local major-haemorrhage pathway when indicated.
- Send urgent investigations, group-and-save/crossmatch as appropriate and review anticoagulants.
- Follow current local/NICE pathways for transfusion, suspected variceal bleeding and medicines.
- Coordinate endoscopy at the urgency required and escalate unstable bleeding immediately.
Red flags that change pace.
- Shock, ongoing haematemesis or rapidly worsening physiology
- Suspected variceal haemorrhage or significant comorbidity
- Continued bleeding despite resuscitation or need for major transfusion
What makes care less safe.
- Underestimating early blood loss because haemoglobin is initially normal
- Delaying specialist/endoscopy contact until resuscitation is complete
- Using risk scores to override instability or clinical concern
Say the concern plainly.
Suspected upper GI bleed with [haemodynamic findings], bleeding history [summary], liver disease/anticoagulation [details] and current response to resuscitation [summary]. I need urgent gastroenterology and senior review for the appropriate endoscopy pathway.