[Upper gastrointestinal bleeding and haemorrhagic shock at the end of the holidays: pre-hospital and in-hospital management of a gastrointestinal emergency].
Upon returning from holidays, a 55-year-old patient presenting with melena and haemorrhagic shock was admitted to a University hospital after receiving first emergency medical care in a German InterCity train. In an interdisciplinary effort, haemodynamics were stabilised and the airway and respiratory function were secured. Under emergency care conditions the patient then underwent an emergency upper GI endoscopy where a spurting arterial upper gastrointestinal bleeding (Forrest 1a) was found. While the bleeding could not be controlled with endoscopic techniques, definitive haemostasis was achieved with a surgical laparotomy. While not commonly established for patients with severe GI bleeding, by spontaneous implementation of an interdisciplinary trauma room approach following established trauma algorithms the team was able to achieve stabilisation of vital functions and final control of bleeding in this highly unstable patient. Although the majority of upper gastrointestinal bleedings spontaneously cease, emergency care algorithms should be developed and implemented for patients with severe gastrointestinal bleedings in shock. Following the case vignette, we discuss a potential approach and develop an exemplary protocol for shock room management in this patient subgroup.
First Medical Department, University Medical Center Mainz, Johannes Gutenberg University Mainz.
M
M
Nguyen-Tat
Department of Internal Medicine, St. Mary's Hospital Frankfurt.
A
A
Hoffman
First Medical Department, University Medical Center Mainz, Johannes Gutenberg University Mainz.
J U
JU
Marquardt
Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg University Mainz.
H
H
Buggenhagen
Second Medical Department, University Medical Center Mainz, Johannes Gutenberg University Mainz.
T
T
Münzel
Department for General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg University Mainz.
W
W
Kneist
First Medical Department, University Medical Center Mainz, Johannes Gutenberg University Mainz.
P R
PR
Galle
Department of Internal Medicine, St. Mary's Hospital Frankfurt.
R
R
Kiesslich
Department of Internal Medicine, St. Mary's Hospital Frankfurt.
J W
JW
Rey
D000465:Algorithms; D003131:Combined Modality Therapy; D003266:Continuity of Patient Care; D004621:Embolization, Therapeutic / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome