03-02-2010, 08:23 PM
A 48-year-old man with a long history of alcohol abuse is brought to the emergency department for evaluation of hematemesis. He has no other known medical problems, takes no medications, and has never established regular care with a physician.
On physical examination, the patient is obviously intoxicated and barely arousable. Pulse rate is 115/min, and blood pressure is 80/49 mm Hg. Spider angiomata are present. Abdominal examination discloses a firm liver edge and splenomegaly. Intravenous fluids are begun, but before blood samples are drawn for laboratory studies, the patient vomits a profuse amount of bright red blood.
Which of the following is the most appropriate management at this time?
A Intravenous β-blocker therapy
B Upper endoscopy
C Red blood cell transfusion
D Endotracheal intubation
E Transjugular intrahepatic portosystemic shunt (TIPS)
On physical examination, the patient is obviously intoxicated and barely arousable. Pulse rate is 115/min, and blood pressure is 80/49 mm Hg. Spider angiomata are present. Abdominal examination discloses a firm liver edge and splenomegaly. Intravenous fluids are begun, but before blood samples are drawn for laboratory studies, the patient vomits a profuse amount of bright red blood.
Which of the following is the most appropriate management at this time?
A Intravenous β-blocker therapy
B Upper endoscopy
C Red blood cell transfusion
D Endotracheal intubation
E Transjugular intrahepatic portosystemic shunt (TIPS)