• 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
• Hypovolemic shock
• Liver failure
• Hepatitis
• Esophagitis
• Gastritis
• Peptic ulcer disease
• Gastric varices
• Mallory Weiss tear
• Pancreatitis
• Portal hypertension
• 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.
• EKG – SR
• CBG – 100
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
Abdominal pain; vomiting blood
• 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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