Live-threatening bleeding - 2018

52-year old man, accompanied by his wife, attends his general practitioner with the complain of vomiting blood. His clothes are soaked with blood, he is pale and feels weak. According to his wife, the husband vomited a large amount of bright red blood in the last 2 hours. He has never had a problem like this before. Denies high temperature or shivering. What will be the GP´s next step?

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Vomiting blood may indicate a serious condition and the GP is first trying to determine the amount of vomited blood and circumstances around the vomiting. Then he makes an assessment of consciousness, measures blood pressure, pulse (heart rate) and respiratory rate. He focuses on auscultation of chest and palpation of the abdomen.

Vomiting blood is related to alcohol ingestion. The GP recommends the patient a therapy for alcohol abuse.

He is carrying out an examination of consciousness, measures blood pressure, pulse (heart rate) and respiratory rate. He examines breathing by auscultation of chest and palpates abdomen. To prevent further vomiting he prescribes prokinetics metoclopramide IV (eg Cerucal 10 mg inj. sol.).

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He has a history of chronic alcoholism (5 beers + 3 snifters every day) and he is treated for hypertension. The man takes regularly Prenessa 4mg 1-0-0 (ACE-inhibitor). Two years without medical checkup.