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A 43-year-old male is brought to the emergency department after his son found him vomiting bright red blood. He is visibly intoxicated, and hospital records indicate a long history of alcohol substance abuse treated with antabuse (disulfiram). Vital signs include T 98.4, HR 89, BP 154/92, and RR 20. EGD is notable for mild esophagitis, and a longitudinal esophageal tear at the gastroesophageal junction, with no active bleeding. What is the next best course of action?
Cyanoacrylate injection and ligation with banding, IV fluid hydration, and NPO
Conservative management with IV fluid hydration and observation
Barium swallow to characterize the depth of mucosal involvement
Esophageal manometry and impedance studies
Calcium channel blockage and Botox injection of the lower esophageal sphincter
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