Emergency Medicine Case Study: Haematemesis

What was the most likely cause of the patient's profuse haematemesis?

What vital sign indicates that the patient is in a state of shock?

Which of the following findings supports the diagnosis of a duodenal ulcer in this patient?

Which factor could have contributed to the patient's elevated heart rate?

What is the significance of identifying the ulcer during the urgent endoscopy?

Patient Presentation

54-year-old male with profuse haematemesis (vomiting of blood).
Vital signs indicate significant instability:
- Temperature: 36.9ºC (normal).
- Oxygen saturation: 94% on air (possible hypoxia).
- Heart rate: 124 beats per minute (tachycardia).
- Respiratory rate: 26 breaths per minute (tachypnea).
- Blood pressure: 82/58 mmHg (indicating hypotension and potential shock).

Clinical Action

Urgent endoscopy performed to achieve haemostasis (control bleeding).
Identified a duodenal ulcer on the posterior wall during endoscopy, a common source of gastrointestinal bleeding.

Potential Complications

Haematemesis suggests possible upper gastrointestinal bleeding, which can lead to significant blood loss and shock.
Ulcer location on the posterior wall of the duodenum can be associated with higher risk of complications such as penetration into neighboring organs or major vessels.

Considerations

Immediate management prioritized due to signs of hemodynamic instability.
Management may involve fluids, blood transfusions, and addressing the underlying cause of the ulcer (e.g., H. pylori, NSAID use).

This quiz examines a clinical case involving a 54-year-old man presenting with profuse haematemesis and shock. Participants will analyze vital signs, diagnosis, and management of duodenal ulcers in emergency settings. Test your knowledge on urgent medical interventions and gastrointestinal emergencies.