Acute onset, hematemesis


• Scene – vitals, EKG, assess

• En route – IV, fluids, vitals

• Hospital – unknown


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance

Mark Shelton Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Hematemesis

Differential Diagnosis

• Hypovolemic shock

• Liver failure

• Hepatitis

• Esophagitis

• Gastritis

• Peptic ulcer disease

• Gastric varices

• Mallory Weiss tear

• Pancreatitis

• Portal hypertension

Patient Workup History

• Patient states – that he vomited blood x 2; onset about ~2 hours.

• Abdominal pain 5/10

• Did not take his lactulose today

• He has not had alcohol for 3 weeks.

Physical Exam

• EKG – SR

• CBG – 100

Editor’s Notes

If the vitals are accurate, this patient has hypotension with borderline bradycardia. If the patient has been compliant with his propranolol, this medication may be blocking a physiologic response to hypotension which SHOULD be tachycardia. Close monitoring of vital signs, establishing excellent IV access are essential aspects of prehospital care for this patient. -Dr. David Spiro Could have discussion in class of the pharmacology of propranolol and if raising the pts pulse/pressure with a Beta agonist is a good idea given the pressure

~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital


• Gender: Male

• Age: 34 years

• Height: Not Available


• Temperature: Not Available

• Heart Rate: 63

• Respiratory Rate: 14

• Pulse Oximetry: 100%

• Blood Pressure: 89/48

Signs and Symptoms

Abdominal pain; vomiting blood

History Medical

• PMH: EtOH abuse, cirrhosis

• Allergies: None

• Dispatch info: Vomiting blood


• Lives in a garage with family


• Lactulose, ciprofloxacin, spironolactone, propranolol, thiamine, furosemide

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