Upper GI Bleed - Interactive Case
Patient Overview
John Doe, 52-year-old male with peptic ulcer disease and chronic NSAID use, arrives with evidence of an upper GI bleed: dark, tarry stools, coffee-ground emesis, hypotension, tachycardia, and signs of possible hypovolemic shock.
Vital signs: T 36.8°C, HR 118, BP 92/58, RR 24, O₂ sat 94% on RA. Skin cool/clammy, mucous membranes dry, cap refill delayed. He just vomited ~200 mL of dark blood.
Key Assessment Findings
- Pale, anxious, hypotensive, tachycardic (possible shock)
- Capillary refill 4 seconds, dryness of mucous membranes
- History of chronic NSAID use, risk for ulceration
- Awaiting lab results (CBC, type & cross, coags, etc.)
Airway protection is critical with active hematemesis. IV access for fluid/blood. Need urgent labs for RBC transfusion evaluation.
Priority Interventions
- Protect airway (position on side, suction PRN).
- Obtain two large-bore IV lines; draw labs.
- Begin fluid resuscitation with normal saline.
- Prepare blood transfusion (PRBCs) if needed.
- Administer IV PPI (e.g., pantoprazole).
- Expect endoscopic evaluation once stable.
Interactive Quiz
Q1: When the patient vomits ~200 mL of blood, what is the priority action?
Q2: Which order should be done first?
Q3: Which findings indicate hypovolemic shock? (Select all that apply)
Q4: Calculate the IV pump rate to infuse 1 unit (~300 mL) PRBCs over 2 hours (mL/hr).
Q5: Which factor most likely contributed to his ulcer/bleed?