A 43-year-old man is brought in on an EMS (emergency medical services) stretcher after a syncopal episode. After obtaining a palpated pressure of 80 mm Hg systolic and heart rate of 120 beats per minute, EMS placed an 18-gauge IV and initiated normal saline (NS) infusion en route to the hospital. The patient relates a history of a 3 to 4 days of dark, tarry stools (about 3-4 times per day). Today he passed out when rising from a seated position. He is currently complaining of mild epigastric pain and lightheadedness. He denies any hematemesis, hematochezia, chest pain, shortness of breath, and any similar past episodes. He admits to tobacco use and drinking 1-2 beers each day and is not regularly under the care of a physician.
On examination, his vital signs are temperature 36.6°C (97.9°F), blood pressure 92/45 mm Hg (after 900-mL IV fluid prior to arrival), heart rate 113 beats per minute, and respiratory rate 24 breaths per minute. The patient is pale with dried, dark stool on the perineum. He has mild tenderness to palpation in the epigastrium but no rebound or guarding. He does not have spider angioma, gynecomastia, palmar erythema, or ascites. The rectal examination reveals grossly melenic stool.
1) What is the most likely diagnosis? Provide Your rationales and citation. What shock stage is he in?
Presented with Classification of Hemorrhagic Stage III and after 900ml IVF resuscitation patient improved to Stage II.
2) What is the best therapy?
Hemorrhagic Shock. Blood Product. IV Fluids
3) Discuss about volume resuscitation and blood transfusion in this case: Target goal, method and guideline recommendation
Clinical Question (Review the course introduction- case study)
• Please make sure you compare/summarize with the most current (national) guideline and your upto date article (study/evidence)
• Make your own conclusion
• submit your article(s)
Malnutrition is common in acutely ill patients, occurring in 30-50% of hospitalized patients. Find two most recent articles related to this topic:
-Clinical Implication for Gastric residual volume check for EN.
Add Citations and References. Use UpToDate.com. See attachments. Elaborate answerers fully.
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