رجل عمره ٦٢ سنة يأخذ أسبرين وإيبوبروفين يومياً لآلام الركبة، وصل للطوارئ بعد قيء دم بلون القهوة مرتين، مع دوخة عند الوقوف. تاريخه: ارتفاع ضغط. العلامات الحيوية: الضغط ٩٢/٥٨، النبض ١٢٢، التنفس ٢٢، التشبع ٩٦٪. الجلد بارد ورطب. ما أولوية الممرض الآن؟

A 62-year-old man taking daily aspirin and ibuprofen for knee pain arrives after vomiting coffee-ground material twice, with dizziness on standing. History: hypertension. Vitals: BP 92/58, HR 122, RR 22, SpO2 96%. Skin is cool and clammy. What is the nurse’s priority now?

1. Give an oral antacid, reassure him and reassess in a full hour
2. Insert an NG tube and lavage with iced water before anything else
3. Prepare urgent endoscopy and keep him NPO without IV fluids
4. Insert two large-bore IVs, start fluids and send a type and crossmatch

Answer: D) Insert two large-bore IVs, start fluids and send a type and crossmatch. He is in early haemorrhagic shock (hypotension, tachycardia, cool skin). Circulation comes first: two large-bore IVs, fluids, and type and crossmatch for transfusion. Endoscopy follows stabilisation, and iced-water lavage is no longer recommended.