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December 2012, Volume 42 Number 12 , p 72 - 72


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


MR. M, 50, ARRIVES at the ED in an ambulance accompanied by his daughter, who says he's confused and complains of feeling faint. He began vomiting at home within the last hour and described the vomit as having a coffee-ground appearance at first, then becoming bright red. He had two episodes of vomiting at home and one during the ambulance ride. Mr. M reports having black, tarry stools for the last few days. Mr. M's daughter informs the healthcare provider that he's recently been drinking heavily.On arrival at the ED, Mr. M's vital signs are: temperature 98.6[degrees] F (37[degrees] C); apical pulse, 120; sinus tachycardia on cardiac monitor; respirations, 24; BP, 90/70; SpO2, 94% on oxygen at 4 L/min via nasal cannula.Mr. M appears older than his stated age. His skin is cool and slightly jaundiced, with multiple ecchymoses. Additional physical assessment findings include ascites and caput medusae. A fecal occult blood test is positive.Based on history and physical assessment findings,

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