Approach to bleeding disorders (coagulopathy) Quiz: Ace Your Exams
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A 54-year-old man presents to the emergency department after vomiting a large volume of black material that morning. Past medical history is significant for alcohol-induced cirrhosis. The patient has not experienced gastrointestinal bleeding in the past. Temperature is 37.0 ºC (98.6 °F), heart rate is 114/min, respiratory rate is 20/min, blood pressure is 92/52 mmHg and oxygen saturation is 99% on room air. The patient appears uncomfortable. He is alert and oriented, and able to answer questions appropriately. Cardiopulmonary examination is within normal limits. The abdomen is soft and nondistended with epigastric tenderness to palpation. Skin examination reveals palmar erythema and spider angiomas on the trunk and bilateral upper extremities. Laboratory results are shown below. What is the best next step in management?
| Laboratory value | Result |
| Serum chemistries | |
| Hemoglobin | 8.4 g/dL |
| Leukocyte count | 11,100 /mm3 |
| Platelet count | 90,000/mm3 |
| AST | 30 U/L |
| ALT | 22 U/L |
| PT | 29s |
| aPT | 27s |
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