new_n_lost
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A Very Simple Answer Slightly Clinical So Dont Complain that U werent Informed
A 70 year old man was admitted with pallor, light-headedness and loss of energy. On the day prior to admission he had reported loose dark stools. Examination revealed a pulse of 90 per minute and a blood pressure of 110/70 mmHg.
Investigations revealed:
Haemoglobin 7.2 g/dL (14-18)
MCV 72 fL. (78-96)
White cell count 11.3 x 109/L (4-11)
Platelet count 480 x 109/L (150-400)
What is the most appropriate next step in his management?
1) Barium meal
2) Blood transfusion
3) Endoscopy
4) Parenteral iron infusion
5) Proton pump inhibitor therapy
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| mytime
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3?
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| mms
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Hb is very low so maybe as first intervention I would think the transfusion followed by an endoscopy
2)
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| SILVER
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2
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| salmonella
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3 ???
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| new_n_lost
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2) Blood transfusion
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| new_n_lost
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There is only one answer here and that is blood transfusion. He has clearly had a major GI bleed since he presents with symptoms of shock with a high resting heart rate and lowish blood pressure the day after what sounds like melena. What is more he has a significant microcytic anemia. He should be resuscitated with blood transfusion and then send for upper GI endoscopy. A barium meal will not help a bleeding vessel. Parenteral iron is for chronic anemia not acute bleeds and proton pump inhibitors, although widely used, have no supportive evidence and are nowhere near as important as giving blood to this man.
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| new_n_lost
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with HB < 8 the pt is considered for Blood transfusion depending upon Age n Symptoms the decision to procede with the transfusion is based
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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No u cant classify this as severe hemorrhage but the question lies that if the Symptoms r there n His Age is 70 yrs old given Plasma Colloids wont help if u wait for Endoscopy it takes time n i believe its not a ER procedure n secondly its a diagnostic/ therapuetic technique. It will not reinstate his health back it will tell u the cause of the bleeding but it wont correct his anemia.
Well UW has a tendency to kill everyone so best of luck
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| new_n_lost
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Epica leave the question n move on to the next question the Answer will come later.
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| epica
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Thanks
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| epica
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mdwannabe online
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Posted: Apr 7, 07 - 04:18 report #7
IV and to Endoscopy... and beyond...he is not hemodinamicaly unstable. Transfusion can wait. If you give blood he ooze it out. You need to fix the problem in intestine. Besides, the blood will take several hours to crossmatch. Endoscopy first!
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Adam
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Posted: Apr 7, 07 - 06:08 report #8
He has dark stool >> It's probably an upper GI bleeding,..
The next step is Endoscopy
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| mms
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From what I remember from the classes I took many many years ago....
he is not hemodynamically instable but with 70 years he has for sure some degree of atherosclerosis (inclusive coronary and carotis) so with hemoglobin = 7 I really wouldn't wait with the transfusion. After prescribing the transfusion I would organize the endoscopy and as soon as the blood arrive it can be given to the patient
Does it really take several hours to cross match ?????? I can't believe that
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| new_n_lost
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Good Discussion Guys Keep It going
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| oldkidontheblock
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His vital signs are stable so what he needs first is to find out the site of blood loss because infusion will be of no use if there is a bleeder there. I would suggest Endoscopy followed by blood transfusion.
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| rock
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i agree with oldkid and the post that epica reposted...thats what i thought too....but sometimes i dont understand these 'what comes first' usmle questions because in real life both would be going on simultaneously...the patients sample would be sent for cross matching and endoscopy scheduled and the patient is started to be prepared for endoscopy.
well if the patient was hemodynamically unstable then it would surely make sense to give him BT asap.
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| epica
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one more
mdwannabe
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Posted: Apr 8, 07 - 10:41 report #3
Gotta go to EGDS. No point of transfusion. He is not in distress, no SOB, no hTN, HR acceptable.
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