A 72-year-old male with alcohol-related cirrhosis presents with profuse hematemesis and shock and hypoxia. Learners must: lead a high-acuity resuscitation in a community based limited resource setting, start evidence-based variceal-bleed adjuncts, activate definitive therapy, and when bleeding remains uncontrolled, perform Minnesota tube placement using a checklist-driven approach.

Goals and Objectives

Expose senior learners and physicians to the time-critical resus + team leadership required for massive UGIB in a patient with liver disease, including escalation to balloon tamponade as a bridge to endoscopic or IR therapy.

CRM

1. Lead an interprofessional team through a complex resuscitation using role clarity, closed-loop communication, and frequent summaries
2. Call for early help and coordinate patient transfer to higher level of care

Medical

1. Recognize likely variceal UGIB in cirrhosis and initiate early adjuncts: vasoactive agent + antibiotics + early definitive therapy activation.
2. Resuscitate hemorrhagic shock (balanced blood products, minimize crystalloid, follow local MHP).
3. Intubate and manage a soiled airway
4. Escalate to Minnesota tube balloon tamponade when bleeding persists despite resuscitation + vasoactive therapy and definitive therapy is activated.