05-30-2009, 02:40 PM
A 78-year-old woman is brought to the emergency department (ED) by ambulance after she complained to her daughter that she required assistance in rising to a standing position after completing a bowel movement. As she helped her mother up, the daughter observed that bright red blood was running in a thin stream down her mother™s inner thighs from her anus and that the bowel water was dark pink in color. She called 911 and emergency medical team (EMT) personnel recorded vital signs of temperature 89.7°F (32.1°C), blood pressure (BP) 95/50 mm Hg, heart rate 114 beats per minute and respiration rate 12 breaths per minute. A large bore peripheral intravenous (IV) was placed before transport and fluid resuscitation started with IV normal saline. On arrival at the ED the woman is alert and oriented with warm pale skin without rash. Vital signs are unchanged after 1 liter normal saline. Pulse oximetry shows 96% O2 saturation on 4 liters supplemental O2 via nasal cannula. Neurologic examination is nonfocal. Chest is clear to auscultation and percussion. Cardiac examination shows a regular rate tachycardia with a S4 and no other abnormalities. During examination, the patient passes bright red blood and clots per rectum. What is the next step in the evaluation and management of this patient?
A. Bowel preparation and colonoscopy
B. Emergent angiography with local vasopressin infusion and embolization
C. Emergent esophagogastroduodenoscopy (EGD) and colonoscopy
D. Nasogastric lavage
E. Radionucleotide scanning with tagged red blood cells (RBCs
A. Bowel preparation and colonoscopy
B. Emergent angiography with local vasopressin infusion and embolization
C. Emergent esophagogastroduodenoscopy (EGD) and colonoscopy
D. Nasogastric lavage
E. Radionucleotide scanning with tagged red blood cells (RBCs