A 72-year-old man is brought to the emergency department with 1 day of black, tarry stools and two episodes of vomiting bright red blood. He has taken naproxen 500 mg twice daily for several months for knee osteoarthritis. He has no known cardiovascular disease, takes no anticoagulants or antiplatelet agents, and has no known liver disease or alcohol excess. On examination he is pale and diaphoretic, with mild epigastric tenderness and no stigmata of chronic liver disease. Rectal examination shows melena. Hemoglobin 68 g/L (130-170), platelets 240 x 10^9/L (150-400), INR 1.1 (0.9-1.2), urea 14.8 mmol/L (2.5-8.0), creatinine 98 umol/L (60-110).
| Heart rate | 112/min |
| Respiratory rate | 22/min |
| Temperature | 36.8 °C |
| O2 saturation | 96%, room air |
| Blood pressure | 96/60 mm Hg |
Question 1 of 28
Which of the following are the most appropriate initial management steps before endoscopy?
Select 3. (0 / 3 selected)
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