Examkin

Soru

Zorluk: OrtaInitial Stabilization and Triage

A 54-year-old man is brought to the emergency department by his wife after he vomited a large amount of bright red blood at home. His medical history is significant for chronic hepatitis C infection and alcohol use disorder. Upon arrival, the patient is lethargic and moans incomprehensibly, opening his eyes only to a sternal rub. Vital signs are temperature 36.2°C (97.2°F), pulse 132/min, blood pressure 78/45 mmHg, respiratory rate 26/min, and oxygen saturation 93% on room air. Physical examination reveals scleral icterus, palmar erythema, and a distended, non-tender abdomen with shifting dullness. Large-bore peripheral intravenous access is obtained, and aggressive volume resuscitation with crystalloids and blood products is initiated. Which of the following is the most appropriate next step in the management of this patient?

  1. Endotracheal intubationCevap
  2. B
    Urgent esophagogastroduodenoscopy
  3. C
    Computed tomography angiography of the abdomen
  4. D
    Intravenous administration of octreotide and ceftriaxone
  5. E
    Placement of a Sengstaken-Blakemore tube

Cevap

Endotracheal intubation
The correct answer is endotracheal intubation. This patient is presenting with massive upper gastrointestinal bleeding, hemorrhagic shock, and a significantly depressed level of consciousness (responding only to painful stimuli). According to standard resuscitation protocols, the ABCs (Airway, Breathing, Circulation) take precedence over all other interventions. This patient's inability to protect his airway in the setting of active hematemesis creates an extremely high risk for massive aspiration and asphyxiation. Therefore, securing the airway via endotracheal intubation is the absolute most urgent next step before any other diagnostic or therapeutic procedure is attempted.

Adım Adım Çözüm

1
Evaluate the patient's hemodynamic status and level of consciousness.
The patient is in hemorrhagic shock (hypotension, tachycardia) and has severe encephalopathy or altered mental status (lethargic, moaning, responding only to pain).
Identifying systemic instability and loss of protective airway reflexes dictates the immediate priorities in resuscitation.
2
Determine the most immediate life-threatening risk prior to treating the underlying condition.
The combination of active massive hematemesis and an unprotected airway (due to altered mental status) creates an imminent risk of aspiration and asphyxiation.
In any trauma or medical resuscitation, the ABCs (Airway, Breathing, Circulation) must be secured before definitive diagnostic or therapeutic interventions.
3
Select the appropriate intervention for the identified primary risk.
Endotracheal intubation is selected as the most appropriate next step.
Intubation provides a definitive, protected airway, allowing subsequent interventions (like endoscopy and pharmacotherapy) to be performed safely.

Anahtar Kavram

In the acute management of severe upper gastrointestinal bleeding, securing the airway via endotracheal intubation is the priority step for patients with altered mental status or massive hematemesis to prevent fatal aspiration.
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Konular

Initial Stabilization and Triage

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