A 65-year-old patient presents to the emergency department with hematemesis and melena. Which of the following is the BEST initial intervention for this patient?
Consult gastroenterology for emergent endoscopy
Obtain an immediate CT scan of the abdomen
Administer intravenous proton pump inhibitors
Establish large-bore IV access and initiate fluid resuscitation
The correct answer is to establish large-bore IV access and initiate fluid resuscitation. In cases of acute gastrointestinal bleeding, the primary concern is maintaining hemodynamic stability. Large-bore IV access (18-gauge or larger) allows for rapid fluid administration and potential blood transfusion if needed. Fluid resuscitation helps to restore blood volume, maintain tissue perforation, and prevent shock.
While other options may be important in managing this patient, they are not the best initial interventions:
Administering proton pump inhibitors is beneficial but secondary to fluid resuscitation.
Obtaining a CT scan is important for diagnosis but not the priority in an actively bleeding patient.
Consulting a gastroenterologist is necessary but should not delay immediate resuscitation efforts.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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