Gastrointestinal
Bleeding
Questions
275.A 51-year-old man is brought to the emergency department (ED) by
emergency medical services (EMS) with a blood pressure (BP) of 90/60 mm Hg,
heart rate (HR) of 110 beats per minute, respiratory rate (RR) of 18 breaths per
minute, and oxygen saturation of 97% on room air. The patient tells you
that he has a history of bleeding ulcers. On examination, his abdomen is
tender in the epigastric area. He is guaiac positive, with black stool. He has
a bout of hematemesis and you notice that his BP is now 80/50 mm Hg, HR
is 114 beats per minute, as he is slowly starting to drift off. Which of the
following is the most appropriate next step in therapy?
a. Assess airway, establish two large-bore intravenous (IV) lines, cross-match for
two units of blood, administer 1 to 2 L of normal saline, and schedule an emergent
endoscopy.
b, Assess airway, establish two large-bore IVs, cross-match for two units of blood,
and administer a proton pump inhibitor.
c. Place two large-bore IVs, cross-match for two units of blood, administer 1 to 2 L
of normal saline, and schedule an emergent endoscopy.
d. Intubate the patient, establish two large-bore IVs, cross-match for two units of
blood, administer 1 to 2 L of normal saline, and schedule an emergent endoscopy.
e. Intubate the patient, establish two large-bore IVs, cross-match for two units of
blood, and administer a proton pump inhibitor.
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