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Unstable upper gastrointestinal bleeding — ABEM Board MCQ

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HardGI/Abdominal emergenciesUnstable upper gastrointestinal bleedingABEM Board

A 71-year-old woman arrives as ESI 2 with syncope and black stools. BP 88/52, HR 124, hemoglobin 6.8 g/dL, BUN 48 mg/dL. She takes apixaban for atrial fibrillation and has ongoing hematemesis. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Resuscitate with blood products, reverse anticoagulation when indicated, and arrange urgent endoscopy

Unstable upper GI bleeding requires hemodynamic resuscitation, transfusion, anticoagulant reversal when appropriate, and urgent endoscopy planning.

Reference: ACG upper gastrointestinal bleeding guideline; ACC anticoagulant reversal pathway