Wednesday, January 9, 2008

Vol 2:2 Question






GI Bleed
A 51-year-old man is brought to the ED by EMS with a BP 90/60 mmHg, HR 110 beats per minute, RR 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 exam, 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 blood pressure is now 80/50 mm Hg, HR is 114 beats per minute, and the patient is starting to drift off. Which of the following is the most appropriate next step in therapy?

a. Assess airway, establish two large-bore IVs, cross-match for two units of blood, administer 1-2 liters of normal saline, and schedule an emergent endoscopy

b. Assess airway, establish two large-bore IVs, crossmatch for two units of blood, and administer a proton pump inhibitor

c. Place two large-bore IVs, crossmatch for two units of blood, administer a 1-2 liters 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 a 1-2 liters of normal saline, and schedule an emergent endoscopy

e. Intubate the patient, establish two large-bore IVs, crossmatch for two units of blood, and administer a proton pump inhibitor

Please submit your answer in the "comment" section. The person with the most correct entries at the end of six weeks will receive a copy of the book PreTest Emergency Medicine.

For more information about the contest, please click here.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training. For more information please refer to the following link.

13 comments:

ArkieRN said...

c. Place two large-bore IVs, crossmatch for two units of blood, administer a 1-2 liters of normal saline, and schedule an emergent endoscopy

AMiB said...

A

NPG said...

A.

lnglegfem said...

answer: a

ptk said...

Answer: A

Anonymous said...

answer is b

The T-Dude said...

I would have to go with option B.

You address the BP and increased HR, you are actively working to stablize the patient and are prepared to move forward with a more invasive procedure while giving the PPI the opportunity help control the bleeding.

prnpenguin said...

a. Assess airway, establish two large-bore IVs, cross-match for two units of blood, administer 1-2 liters of normal saline, and schedule an emergent endoscopy.

cotrimaxazol said...

a

cotrimaxazol said...

a

ditzydoctor said...

A! :)

HicksterAZ said...

A

Pro et Contra Medic said...

A- i think is the answer.

It’s great of you to have made this quiz, just for the fun of it. Good written and excellent for revision!