A 51-year-old man walks into the ED after a week of vomiting blood, and by the time he arrives, his haemoglobin is 5.8 g/dL. Hosts Dr. Daniel Olinga and Dr. Emmanuel David sit down with Emergency Medicine physician Dr. Emuron to unpack a real case of upper gastrointestinal bleeding (UGIB), tracing the patient's journey from pre-hospital care through resuscitation, diagnosis, and disposition.

Key Discussion Points:

• Pre-hospital priorities for a suspected UGIB patient: IV access, careful fluid resuscitation, positioning, and a tight ISBAR handover
• Reading the primary and secondary survey — why "compensating" is not the same as "stable," and what clues like spider naevi, pitting oedema, and melaena reveal
• Building the differential: peptic ulcer disease, oesophageal/gastric varices, erosive gastritis, Mallory-Weiss tear, Dieulafoy lesion, and bleeding gastric carcinoma
• Blood vs. fluids — why crystalloid-heavy resuscitation can backfire, and the case for a restrictive transfusion strategy (Hb target 7–8 g/dL)
• The TXA debate — what the HALT-IT trial (12,000+ patients) actually showed about tranexamic acid in UGIB, and why it's not recommended here
• Airway management thresholds — when to intubate a GI bleed patient, including the pre-endoscopy scenario
• Solving the hyperbilirubinaemia puzzle — haemolysis vs. hepatocellular stress vs. gut-derived haem load
• Why pre-transfusion Hepatitis B testing matters even when the blood bank screens donor units
• Hospital course: endoscopy, H. pylori testing, PPI therapy, NSAID cessation, and screening for undiagnosed chronic liver disease

Takeaways:

1. Compensated ≠ stable — monitor relentlessly, because deterioration can be sudden
2. Resuscitate with blood, not fluid — target Hb 7–8 g/dL
3. TXA has no proven benefit in UGIB and raises VTE risk — skip it
4. Intubate based on genuine airway risk: falling GCS, active haematemesis, or pre-scope in a vomiting patient
5. Always ask about NSAID use by name — it can change both the diagnosis and the discharge plan Listen to learn. Share to save lives. Mastering Emergency Care

Disclaimer: For Educational Purposes only, refer to guidelines for definitive management

Show Notes & Resources:

· Watch the Full Case Video: https://youtu.be/qZZ86tknD8k?si=Pczbbe-vqvcti80V