MRCP2-2065
A 65-year-old man on the gastroenterology ward experiences an acute episode of haematemesis during the night. The nurse who witnessed the event reported that the bleed was approximately one cupful of bright red blood. The patient has a history of heavy alcohol consumption, drinking 2 bottles of whiskey a day, and has a past medical history of ascites secondary to alcoholic liver cirrhosis, hypertension, and type two diabetes mellitus. He was admitted initially for an ascitic drain earlier in the afternoon, which has not occurred due to staff shortages in the medical team.
Upon examination, the patient was afebrile, with a heart rate of 110 bpm, blood pressure of 104/81 mmHg, respiratory rate of 20 breaths per minute, and an oxygen saturation of 97% on air. Cardiovascular and respiratory examination was unremarkable. Abdominal examination revealed a tensely distended abdomen with shifting dullness present. There were marked distended superficial veins on his abdominal surface. There was mild epigastric tenderness, and on rectal examination, there was a small amount of tarry black stool. He was not actively vomiting during the examination.
The house officer on call had already started intravenous fluid resuscitation, and blood samples including a cross-match were sent. The gastroenterology registrar on call has been informed and was arranging an emergency endoscopy for the patient.
His previous blood results and a current venous blood gas (VBG) results are shown:
Blood results (earlier in the afternoon)
Na+ 134 mmol/l
K+ 4.8 mmol/l
Urea 10.9 mmol/l
Creatinine 100 µmol/l
Serum bilirubin 30 µmol/l
Serum alkaline phosphatase 165 IU/l
Serum aspartate aminotransferase 68 IU/l
C Reactive protein 6 mg/l
Haemoglobin 126 g/l
White cell count 7.6 x 10^9/L
Platelets 122 x 10^9/L
INR 1.8
VBG (Current)
pH 7.368
Lac 1.8 mmol/l
Base Excess -2.4 mmol/l
Bicarbonate 26.9 mmol/l
Hb 11.0 g/dL
What is the next most appropriate immediate course of action to take?