Last week (7 January, BMJ 2006;332: 33), we described the case of Mr Bond, who has alcoholic liver disease and presented with haematemesis. The key to his initial management was resuscitation. He was tachycardic, which may partly have been due to alcohol withdrawal and agitation but probably suggested a haemodynamic response to a clinically important bleed. His heart rate was notably raised given that he was taking β blockers.

Mr Bond was stabilised in the accident and emergency department with aggressive fluid resuscitation through large bore cannulas. Blood was cross-matched, and he was given intravenous vitamin K and tranexamic acid to correct his clotting abnormalities. After resuscitation Mr Bond had gastroscopy to establish the cause of …