ABSTRACT
This chapter presents a case study of a 52-year-old man who is brought to the Emergency Department by an ambulance after suffering from a 'fainting' episode at work. He also reports gnawing abdominal pain for the past few hours and vomited dark material on one occasion a few hours earlier. The patient presents with a syncopal episode in the setting of likely haematemesis and evidence of melaena on physical examination. In this patient, the history of regular use of ibuprofen makes peptic ulcer disease the most likely cause as this, like other non-steroidal anti-inflammatory drugs (NSAIDs), causes gastric mucosal damage by inhibiting production of prostaglandins, which protests the mucosa. Immediate management should proceed along the 'ABCDE' approach, with consideration of intubation for airway protection in patients with ongoing haematemesis, establishment of at least two sites of large-bore intravenous access and administration of crystalloid fluid boluses.
