Laparotomy for Upper GI bleeding

2 assistants
Head light
Do upper GI scope yourself first
Midline laparotomy
Omintract/Book Walter (if unstable don't bother, just open and compress bleeding site if known, if not cross clamp aorta to allow anaesthetist to catch up)
Gastrotomy
GIA stapler to make gastroduodenotomy: wide access
Pack above and below (swab into duodenum)
identify bleeder: if posterior wall duodenum/GDA, suture PDS in north, south, east and west position
If cancer: consider oversew if can't do proper cancer operation (controversial)
Varices: Sengstaken Blakemore and get out
Gastroenterostomy of concern re pyloric stenosis
If bleeding site unknown, sequential Teflon tape through small bowel and observe for bleeding segment

No shame in unscrubbing to call a senior colleague and get advice