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.

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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.