What does the evidence suggest should be theinitial step in management for our patient witha suspected UGIB?

There are currently no direct, evidence-based recommendations for the initial management of suspected UGIB. However, current standard of care necessitates a focused medical history, physical examination, and initial laboratory values such as complete blood count (CBC), serum chemistry, liver “function” tests (LFTs), and coagulation profile. When managing any acutely ill patient, standard practice includes evaluating the airway, breathing, and circulation (ABCs) of the patient. It is also important to assess for signs of hemodynamic instability such as hypotension and tachycardia that may indicate a severe or chronic bleed, and if necessary, start fluid resuscitation.6 Patients with evidence of hypotension secondary to hemorrhage have an approximate 3-fold increase in mortality if not immediately managed.7-10 Our patient presents with resting tachycardia (HR: 105 bpm) and probable hypotension (BP: 104/74 mm Hg), suggesting mild to moderate hypovolemia.

Bottom line: Assessing a patient’s hemodynamic status is perhaps the most critical initial step in managing patients with suspected UGIB. Routine blood work should include CBC, electrolytes, kidney function, LFTs, and coagulation profile.

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