peraspera
Forum Elite
Topics: 38
Posts: 233
|
A 57-y.o. man seeks attention in the ER for weakness and melena, which he has had for 3 days. He says he has not had significant abdominal pain and had no prior GI bleeding. On exam he is disheveled and unshaven, appears older than his stated age, and has a 20 mmHg orthostatic drop in blood pressure. Findings include bilateral temporal wasting, anicteric and pale conjunctivae, spider angiomas on his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without abdominal tenderness to palpation. Stool is melenic. Nasogastric aspiration reveals " coffee-grounds" material, which quickly clears with lavage. Hematocrit is 30 %, and MCV is 105 fL. Saline gastric lavage is initiated. The appropriate next step in the managment of this man's illness would be to:
A. perform gastroscopy
B. pass a Sengstaken-Blakemore tube and begin an IV infusion of
vasopressin ( Petressin)
C. order an upper gastrointestinal series
D. order immediate visceral angiography
E. insert a large-bore IV line and type and cross- match the man's blood
|
| dr in trouble
Forum Guru
Topics: 62
Posts: 601
|
A--gastroscopy--indicated in al cases of upper GI bleed after bleeding stop. The man most likely is suffering from Hepatocellular cirrhosis.
___________________
If u want to do something, do it today as there is no tomorrow.
|
| kpmle2
Forum Elite
Topics: 60
Posts: 381
|
E. insert a large-bore IV line and type and cross- match the man's blood
|
| docfor99
Forum Senior
Topics: 10
Posts: 111
|
now the best initial management would be inserting a large bore needle and typing blood...
|
| dermatology
Forum Elite
Topics: 30
Posts: 297
|
appropriate next step wud b blood cross matching and typing with large bore iv lines ....
looks like alcoholic with portal hyper tension and ruptured esophageal varices..
|
| starcraftbw
Forum Senior
Topics: 13
Posts: 166
|
E
stabilize the pt first with 2 large 16G needle + T&C match blood + open IVF ==> then find out the causes
|
| Dr.D
Forum Senior
Topics: 22
Posts: 191
|
E
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,609
|
The patient should be stabilized prior to endoscopy and abnormalities in coagulation should be corrected.
Therefore i will go with E
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| starcraftbw
Forum Senior
Topics: 13
Posts: 166
|
E.
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,609
|
What is the answer pz
___________________
92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
|
| peraspera
Forum Elite
Topics: 38
Posts: 233
|
|
|
| |
| | | | | | | | | | | |
