Vol 2:2 Answer

Thank you to everyone who participated.

The Question

The answer is a.

Emergency Medicine always starts with an assessment of the patient’s airway. For patients suspected of having a significant GI bleed, two large-bore IV lines need to be established rapidly. Treating an undifferentiated upper GI bleed is like treating a gun shot wound to the abdomen—you should expect the worse. Immediate volume resuscitation should begin with 1-2 liters of normal saline. If there is no improvement in the blood pressure of a hypotensive patient, then blood should be administered. Sending a crossmatch early is advisable since it can take up to an hour to retrieve.

(b) A proton-pump inhibitor may be administered but priority is to the ABCs and this patient is hypotensive. (c) You must assess airway first. (d) and (e) The patient is maintaining his airway and does not need to be intubated emergently.


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