A 60s M arrives via ems with hematemesis x 2-3 days. His main complaint is feeling weak. He has no hx of gi bleed. He is on coumadin for a dvt. He has a hx of mi and htn. The hematemesis has been on and off for 2-3 days, and sounds like large-volume. He denies sob or chest pain; he reports mild LUQ pain. When asked, he reports dark stools. On exam his HR is 97, RR 22, BP 85/46, and T 97.8. He is not vomiting. The conjunctiva are pale and the abdomen is not tender. His mental status is excellent. How do we treat this patient?
Do we give saline, blood, ffp now?
Do we put in an ngt or do a rectal exam?
Does gi need to come in right now?
What is our plan if the patient makes troponin?
– No saline.
– The HR is useless in this case, probably on a CCB or BBlocker, have to assume that the hypotension is real. So yes, FFP and Blood.
– NGT unnecessary (and possibly cruel). Rectal exam is in reality unnecessary also, but I would do it to make a more convincing case to GI and/or CCM (depending on the patient’s clinical course).
– I don’t really need GI yet, I would do some resuscitation first and see (they wouldn’t scope him anyway at this point). But honestly I might call them anyway at our institution because I would want them on their way if/when the patient decompensates.