A 58-year-old man is brought to the emergency department after vomiting bright red blood twice and passing black, tarry stool this morning. He has alcohol-related cirrhosis with ascites, has never had an endoscopy, and takes spironolactone and furosemide. He feels light-headed on sitting up, and on examination he is pale and drowsy but rousable, with spider angiomata, a distended abdomen with shifting dullness, and no asterixis. Two large-bore IV lines have been inserted and IV fluids have been started. Hemoglobin 86 g/L (135-175), platelets 62 x10^9/L (150-400), INR 1.7 (0.9-1.2), creatinine 96 umol/L (60-110), albumin 28 g/L (35-50), total bilirubin 44 umol/L (less than 21).
| Heart rate | 126/min |
| Respiratory rate | 22/min |
| Temperature | 36.8 °C |
| O2 saturation | 95%, room air |
| Blood pressure | 84/50 mm Hg |
Question 1 of 6
Which of the following medications are the most appropriate to start now, before endoscopy?
Select 2. (0 / 2 selected)
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