A 58-year-old male known for alcoholism presents to the emergency department with a two-day history of hematemesis with an active, massive upper GI bleed due to esophageal varices. The patient deteriorates into hypovolemic shock requiring medical management, blood transfusions, intubation for airway protection and insertion of a Blakemore tube before definitive management.

Goals and Objectives

Educational Goal: To manage a patient who presents to the ED with a massive UGIB.

CRM Objectives:

1) Anticipate and appropriately plan for intubation in a patient with a significant UGIB
2) Consider a massive transfusion strategy in a non-trauma context

Medical Objectives:

1) Employ adjunctive medications in the treatment of an undifferentiated massive UGIB including octreotide/somatostatin analogues, intravenous proton pump inhibitor, and broad-spectrum antibiotics.
2) Prioritize airway management and Blakemore tube insertion for the stabilization of a patient with a massive UGIB prior to definitive therapy.
3) Recognize the importance of limited crystalloid therapy and early blood transfusion in the setting of hypovolemic shock secondary to UGIB.