GOGETA
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A 46-year-old man with a history of alcoholism and known cirrhosis comes to the emergency department because of the abrupt onset of hematemesis. On physical examination, he is obtunded and confused. Temperature is 37.7 C (99.9 F), pulse rate is 100/min and regular, respiration rate is 20/min, and blood pressure is 90/60 mm Hg. He is not jaundiced. Rectal examination discloses black, tarry stool in the rectal vault. Hemoglobin is 10.6 g/dL, the platelet count is 70,000/μL, the INR is 2.4, and serum albumin is 3.0 g/dL.
Which of the following has the lowest priority in the initial management of this patient?
A. Immediate upper endoscopy
B. Fluid resuscitation
C. Endotracheal intubation
D. Transfer to the intensive care unit
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| me007
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A?
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| usmle99
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C
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| treblechar
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a. patient is having hepatic enceph
"Patients with acute liver failure and grade 3 or 4 hepatic encephalopathy should undergo
elective ventilation, sedation with fentanyl, and paralysis with atracurium both to protect the airway and to facilitate the management of cerebral edema by preventing surges in intracranial pressure related to psychomotor agitation." - NEJM
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| darkhorse
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A.
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| cool doctor
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A
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| GOGETA
I'm Dr. GOGETA
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Posts: 2,710
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The correct answer is A
Educational Objectives
Recall the most appropriate initial management for a patient with acute upper gastrointestinal bleeding.
Critique
Upper endoscopy should not be performed immediately because the patient must be resuscitated, stabilized, and intubated for airway protection prior to this procedure. If upper endoscopy is done immediately, the patient is at high risk for aspiration or other cardiopulmonary complications.
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As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
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