A 54-year-old man is brought to the emergency department by his partner after vomiting a large amount of bright red blood at home. He has a known history of alcohol use disorder and cirrhosis. On arrival, he is lethargic and visibly pale. Vital signs reveal a heart rate of 134/min, a blood pressure of 78/46 mm Hg, a respiratory rate of 22/min, and an oxygen saturation of 96% on ambient air. His abdomen is distended but non-tender. Which of the following is the most appropriate initial step in the stabilization of this patient?
- Insertion of two large-bore peripheral intravenous lines and rapid crystalloid administrationAnswer
- BUrgent performance of an esophagogastroduodenoscopy
- CAcquisition of a computed tomography angiogram of the abdomen
- DInsertion of a nasogastric tube to quantify the volume of hemorrhage
- EImmediate transfer to the intensive care unit for comprehensive management
Answer
The correct answer is the insertion of two large-bore peripheral intravenous lines and rapid crystalloid administration.
The correct answer is the insertion of two large-bore peripheral intravenous lines and rapid crystalloid administration. This patient is presenting with hemorrhagic shock secondary to a massive upper gastrointestinal bleed, likely from esophageal varices given his history of alcohol use and cirrhosis. In any hemodynamically unstable patient, the absolute first priority is the stabilization of airway, breathing, and circulation (ABCs). Because his airway and breathing are currently maintained, immediate circulatory support with volume resuscitation via large-bore intravenous access is the most critical and urgent next step. Securing access allows for rapid infusion of crystalloids and subsequent blood products to restore end-organ perfusion.
Step-by-Step Solution
Key Concept
In hemorrhagic shock, immediate stabilization of circulation with large-bore intravenous access and fluid resuscitation takes absolute priority over diagnostic procedures or disposition.
Estimated Time:1m 0s