goneskuba
Forum Junior
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Posts: 47
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A 71-year-old man presents to the hospital with an episode of bright red blood per rectum. The patient reports that, a few hours ago, he passed a grossly bloody bowel movement. The passage was associated with some cramping, lower abdominal pain. The patient's past medical history is significant for coronary artery disease and a myocardial infarction 3 years ago. He is poorly compliant with his beta blocker and diuretic therapy, and his blood pressures have run around 140/85 mm Hg. While the patient is on the floor, he has another episode of large-volume, bright red blood per rectum. His blood pressure is 100/60 mm Hg while supine, and his pulse is 120/min. His hematocrit is 28%. He then begins to complain of substernal chest tightness radiating to his left shoulder. An ECG shows new T wave inversions in the anterior leads. Which of the following is the most appropriate intervention at this juncture?
a)Administration of aspirin by mouth
b)Administration of a beta blocking agent
c)Administration of nitroglycerin sublingually
d)Administration of nitroglycerin topically
e)Blood transfusion
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| omega
Forum Newbie
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Posts: 7
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e is the best answer i think
his ischemic changes on the EKG are due to the acute anemia resulting from his blood loss therefore due to decreased O2 transport capacity of blood
also this is the treatment of choice to stablize hemodynamically an ongoing loss of blood and then treat the underlying cause (weather endoscopically or by surgery for refractory cases). Note also that lower GI bleeding stop spontaneously in 80-90% of cases.
Also Beta-blockers will decrease blood pressure and stops the needed vasonconstrictive reflex
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| mdwannabe
Forum Guru
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I agree. Hematcrt 28%... better transfuse.. No Nitro.
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| Anil Kumar980
Forum Senior
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So do I .Its a case of diffuse subendocardial ischemia n its always treated with a transfusion.
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| merrk
Forum Elite
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Me too. Hb is less than 10 (hct /3). When the pt is actively bleeding that's an indication for transfusion. (Surgery Recall)
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| mocherla
Forum Newbie
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Mocherla
I say give sublingual nitroglycerine first to take care , his chest pain, as its going to be a while to get blood cross matched and arrange blood for transfusion.
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| merrk
Forum Elite
Topics: 27
Posts: 280
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His bp is too low (100/60) to give sublingual nitro
topical would be better.
what's the right answer?
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| dr.shar
Forum Elite
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Posts: 236
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may i know the ans please
my ans is e
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| dimps
Forum Guru
Topics: 63
Posts: 446
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i think answer should be E.....Blood transfusion
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