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October 2011, Volume 41 Number 10 , p 72 - 72


  • Dorothy S. Carlson DEd, RN
  • Ellen Pfadt RN


Mr. D, 47, ARRIVES in the ED complaining of heaving and forceful vomiting with blood for the past 3hours. Although the vomiting stopped, he says he feels like passing out when he stands up. You assess Mr. D and find that he's pale and diaphoretic. His vital signs are temperature, 99o F (37.2o C); pulse, 120 and regular; respirations, 28; BP, 94/60; and SpO2, 93% on room air.You position Mr. D supine with the head of the bed flat, provide supplemental oxygen via non-rebreather mask, place him on a cardiac monitor, which shows sinus tachycardia, and obtain peripheral venous access. Abdominal assessment reveals a soft, nondistended abdomen with hyperactive bowel sounds. Peripheral pulses are 2+ and capillary refill time is less than 3 seconds. After your assessment, Mr. D vomits 250 mL of bright red blood.Mr. D has a history of dyslipidemia and takes simvastatin. He says he was celebrating a friend's birthday with "quite a few" shots of alcohol and several servings of picnic food. He tells

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