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| Image Credit: Gregory Wanner, DO PA-C |
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| This post was peer reviewed. Click to learn more. |
Emergency Medicine Resident, PGY-3
AAEM/RSA Publications Committee Chair '16-'17
Author: Dimitrios Papanagnou, MD, MPH, EdD(c)
Assistant Professor, Emergency Medicine
A version of this article was previously published on the Jefferson Emergency Medicine Residency Blog (www.jeffem.org), March 2016.
It’s 3 am on a Saturday and you’re covering the emergency department at a community hospital. You hear a nurse’s firm but slightly nervous-sounding voice from down the hall say, “Umm, I need some help in here.”
You enter the room and find a geyser of blood erupting from the mouth of a middle-aged, male patient. His family informs you that he is a heavy drinker and has “liver problems”.
What do you do?
After applying triple-G protection (gown, gloves, and goggles), you slide towards the patient and begin to perform the critical actions associated with establishing large bore IV access, securing the airway, transfusing blood, starting octreotide, and calling GI. The patient keeps bleeding. He is severely hypotensive and GI is unavailable.
