A 50s F with a hx of alcohol abuse comes in with coffee-grounds emesis. She is holding an emesis bag containing approx 300-400 ml of coffee-grounds emesis. Vitals are HR 110, RR 20, BP 146/98, T 97. How do we proceed?
Jacobi / Montefiore Emergency Medicine Residency
Assess ABCs. Place 2 large bore IVs and draw basic labs (including T&S and coags). Order PRBCs and have them ready for transfusion. May also need platelets if they’re low. Start PPI drip, IVFs and consult GI stat. Keep NPO. Pt is not hypotensive yet, but she’s tachycardic, so she’s mildly hypovolemic and if she continues to bleed, she can decompensate very quickly. CCM consult should also be called for potential MICU boarding.