Updated: 1/10/2022

Upper GI Bleed

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(M2.GI.14.15) A 55-year-old man presents to the emergency department with hematemesis that started 1 hour ago but has subsided. His past medical history is significant for cirrhosis with known esophageal varices which have been previously banded. His temperature is 97.5°F (36.4°C), blood pressure is 114/64 mmHg, pulse is 130/min, respirations are 12/min, and oxygen saturation is 98% on room air. During the patient's physical exam, he begins vomiting again and his heart rate increases with a worsening blood pressure. He develops mental status changes and on exam he opens his eyes and flexes his arms only to sternal rub and and is muttering incoherent words. Which of the following is the most appropriate next step in management?

QID: 102594

Emergency surgery

0%

(0/10)

Emergency variceal banding

10%

(1/10)

Intubation

60%

(6/10)

IV fluids and fresh frozen plasma

20%

(2/10)

Transfuse blood products

10%

(1/10)

M 7 E

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(M3.GI.12.13) A 65-year-old man presents to the emergency department with blood in his vomit. The patient is an immigrant and has no known past medical history. He drinks alcohol regularly, endorses IV drug use, and is currently sexually active with both men and women. His temperature is 99.4°F (37.4°C), blood pressure is 166/104 mmHg, pulse is 82/min, respirations are 22/min, and oxygen saturation is 99% on room air. Physical exam is notable for an obese man with a distended abdomen. A fluid sample is sent from the fluid collection seen in Figure A. During the patient's exam, he begins vomiting bright red blood again. He stops vomiting after receiving omeprazole and ondansetron. Laboratory studies are ordered as seen below.

Hemoglobin: 7.9 g/dL
Hematocrit: 25%
Leukocyte count: 8,200/mm^3 with normal differential
Platelet count: 192,500/mm^3

The patient is started on IV fluids. Which of the following is the most appropriate next step in management?

QID: 102642
FIGURES:

Balloon tamponade

11%

(2/19)

Esophagogastroduodenoscopy

53%

(10/19)

Nadolol

16%

(3/19)

Packed red blood cells

11%

(2/19)

Transjugular intrahepatic portosystemic shunt

5%

(1/19)

M 11 E

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Evidence (9)
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