01-31-2014, 04:32 PM
72 year old man comes to the ER because he vomited blood three times during the past 12 hours. He has had dizziness during this period. He has 5 year history of arthritis treated with daily ibuprofen. Over past 4 weeks, he has increased his daily dose of ibuprofen because of worsening joint pain but is not sure how many pills he has been taking. He has been unable to take his daily walks because of the joint pain. He has not had chest pain. He had an uncomplicated myocardial infarction 10 years ago. He appears pale. His temperature is 37.5 deg C (99.5 deg F), pulse is 110, respirations 24, blood pressure 90/60. Examination shows dried blood near the mouth. The lungs are clear to auscultation. Heart sounds are normal. The stool is black, and test for occult blood is positive. His hematocrit is 22%, and platelet count is 215,000. Upper endoscopy shows hemorrhagic gastritis with no active site of bleeding. Thirty minutes after fluid resuscitation with crystalloid solution and transfusion of 4 units of crossmatched packed red blood cells, the patient has shortness of breath. Diffuse rhonchi about crackles are heard bilaterally. Which of the following is the most likely cause of the dyspnea?
A) ABO incompatibility
B) Acute respiratory distress syndrome
C) Aspiration of gastric contents
D) Fluid overload
E) Pulmonary embolism
A) ABO incompatibility
B) Acute respiratory distress syndrome
C) Aspiration of gastric contents
D) Fluid overload
E) Pulmonary embolism