EMERGENCIES ALL SHOULD KNOW:HAEMETEMESIS(BLOOD VOMITINGS)

HAEMETEMESIS(BLOOD VOMITINGS)

Haemetemesis is the vomiting of blood. The source is generally the upper gastro-intestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood).

The causes are esophageal tears secondary to prolonged retching/vomitings,peptic ulcer with vascular erosion,tumours in esophagus/stomach,esophageal varices,vascular malformations, portal hypertension, some drugs like aspirin,anti-coagulants,blood dyscrasias ,chronic alcoholism etc.

Hematemesis is treated as a medical emergency. The most vital distinction is whether there is blood loss sufficient to cause shock.The blood may be bright red or coffee ground in colour(blood mixed with gastric juice).If there is associated tarry stools it suggests there is significant GI bleed. 

The patient is started on antacids,i.v.drugs like omeprazole,and given blood transfusions (if the level of Hb is extremely low, that is less than 8.0 g/dL.He is kept NBM which stands for Nothing By Mouth.He will be planned for Upper GI Endoscopy for accurate diagnosis and simultaneous treatment in most of the cases.A ryles tube is usually inserted into the stomach through nose for any medicines or monitor the stomach fluids for blood.

If a person starts vomiting blood along with symptoms like confusion,nausea,fainting,rapid shallow breathing and cold clammy limbs, it is a sign of impending shock and needs ICU admission.

In a "hemodynamically significant" case of hematemesis, that is hypovolemic shock, resuscitation is an immediate priority and patient is prepared for emergency endoscopy, which is typically done in theatres under anaesthesiologist care and support.

The endoscopist controls the bleeding by injecting a sclerosing agenton the ulcer bed or banding the esophageal varices or laser is used sometimes to control the bleeding.

Surgeons opinion is sought in case the source of bleeding cannot be identified endoscopically, and laparotomy is necessary to control the bleeding . Securing the airway is a top priority in hematemesis patients, especially those with a disturbed conscious level (hepatic encephalopathy in bleeding esophageal varices) .A cuffed endotracheal tube to secure the airway from aspirating the bloody vomitus.
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• THROMBOSED,PAINFUL PILES
  ACUTE TUBULAR NECROSIS
  PARAPHIMOSIS
  TESTICULAR TORSION
  TRAUMA
  RENAL COLIC
  PRIAPISM
  ACUTE URINE RETENSION
  SEVERE PALLOR
  ABSCESS
  ANIMAL BITES
  POISONING
  BURNS
  SEIZURES
  PARALYTIC STROKE
  ANY PREGNANCY RELATED EVENT
  SUDDEN LOSS OR IMPAIRMENT OF VISION
  SUDDEN HEAD ACHE AND VOMITING
  HIGH GRADE FEVER
  NON-RESPONSIVENESS
  VIOLENT BEHAVIOUR
  SUDDEN CALF PAIN
  SEVERE BREATHLESSNESS