A 68-year-old male with heavy alcohol use is found with coffee-ground emesis and hypotension. Which initial management step is most appropriate?

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Multiple Choice

A 68-year-old male with heavy alcohol use is found with coffee-ground emesis and hypotension. Which initial management step is most appropriate?

In this scenario the priority is restoring intravascular volume to treat presumed hypovolemic shock from a GI bleed. A rapid infusion of isotonic crystalloids, about 20 mL/kg, is the best initial move because it quickly expands the circulating volume, improves coronary and cerebral perfusion, and raises blood pressure. This first step addresses the life-threatening problem directly. An antiemetic like Zofran helps with nausea but does not correct the hemodynamic instability. A vasopressor such as dopamine is not the first choice until after volume status has been repleted; starting a pressor before adequate fluids can worsen tissue perfusion and requires careful monitoring. Dextrose-containing fluids like D5W do not effectively expand the intravascular compartment and can dilute plasma, offering little help for the shock. After the bolus, the patient should be reassessed and managed further with additional fluids, blood products if needed, and definitive care for the bleed.

In this scenario the priority is restoring intravascular volume to treat presumed hypovolemic shock from a GI bleed. A rapid infusion of isotonic crystalloids, about 20 mL/kg, is the best initial move because it quickly expands the circulating volume, improves coronary and cerebral perfusion, and raises blood pressure. This first step addresses the life-threatening problem directly.

An antiemetic like Zofran helps with nausea but does not correct the hemodynamic instability. A vasopressor such as dopamine is not the first choice until after volume status has been repleted; starting a pressor before adequate fluids can worsen tissue perfusion and requires careful monitoring. Dextrose-containing fluids like D5W do not effectively expand the intravascular compartment and can dilute plasma, offering little help for the shock. After the bolus, the patient should be reassessed and managed further with additional fluids, blood products if needed, and definitive care for the bleed.

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