You are an FY1 on the gastroenterology ward, and a nurse calls you to urgently review Mr. John Smith, a 68-year-old male with alcohol-related cirrhosis, who has just been seen vomiting a large amount of blood. The nurse mentions the patient is feeling lightheaded and weak especially upon standing. The nurse recalled Mr Smith denied any recent trauma, but mentions a long-standing history of alcohol use (10-15 units daily) and NSAID use (ibuprofen for chronic joint pain).

Past Medical History:

Hypertension

Chronic liver disease (alcohol-related cirrhosis).

Peptic ulcer disease (previously treated with proton pump inhibitors).

Medications:

Amlodipine 5 mg daily.

Omeprazole 20 mg daily

Ibuprofen occasionally for joint pain.

You decide to do an A-E assessment on Mr Smith