Gastrointestinal Bleeding 303286.A 49-year-old man is brought to the ED by EMS stating that he vomited
approximately three cups of blood over the last 2 hours. He also complains
of epigastric pain. While examining the patient, he has another episode of
hematemesis. You decide to place a NG tube. You insert the tube, confirm
its placement, and attach it to suction. You retrieve 200 mL of coffee-ground
blood. What is the most common etiology of an upper GI bleed?
a. Varices
b. Peptic ulcer
c. Gastric erosions
d. Mallory-Weiss tear
e. Esophagitis
287.A 68-year-old man presents to the ED 4 hours after an upper endoscopy
was performed for 5 months of progressive dysphagia. During the procedure,
a 1-cm ulcerated lesion was found and biopsied. Now, the patient complains
of severe neck and chest pain. His vitals are as follows: BP 135/80 mm Hg, HR
123 beats per minute, RR 26 breaths per minute, and temperature 101°F. O n
physical examination, he appears diaphoretic and in moderate distress with
crepitus in the neck and a crunching sound over the heart. You obtain an elec-
trocardiogram (ECG), which is notable for sinus tachycardia. After obtaining
a surgical consult, which of the following is the next best step in management?
a. Perform an immediate bronchoscopy.
b. Give aspirin 325 mg and obtain a cardiology consult for possible cardiac
catheterization.
c. Repeat the endoscopy to evaluate the biopsy site.
d. Perform an immediate thoracotomy.
e. Order an immediate esophagram with water-soluble agent.