You are dispatched to an assisted living center for an 80-year-old woman who is vomiting bright red blood. Upon your arrival, you find the patient sitting in a chair. She is conscious and alert, but is markedly pale and diaphoretic. Her medical history is significant for hypertension, congestive heart failure, type 2 diabetes, hypothyroidism, and osteoarthritis. Her medications include Toprol, lisinopril, Glucophage, Synthroid, and ibuprofen. Her blood pressure is 76/56 mm Hg, pulse is 76 beats/min and weak, and respirations are 24 breaths/min and shallow. Which of the following statements regarding this scenario is MOST correct?

Question

A) You should suspect shock due to lower gastrointestinal bleeding, start two large-bore IV lines, and rapidly infuse normal saline until her systolic blood pressure is greater than 90 mm Hg.
B) Gross hematemesis suggests gastrointestinal bleeding; however, although she is in shock, you should avoid infusing isotonic crystalloid solutions due to her congestive heart failure.
C) This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.
D) This patient's vital signs are clearly the result of the medications she is taking, and you should focus on the likelihood that her pallor and diaphoresis are most likely the result of hypoglycemia.

Answer 1

Answer: C) This patient, who is in shock, probably has a bleeding peptic ulcer secondary to ibuprofen use, and the lack of compensatory tachycardia is likely the result of the beta blocker she is taking.