Approach to melena and hematemesis Quiz: Ace Your Exams

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A 45-year-old man is seen in the emergency department for weakness and vomiting up blood. The patient coughs up small amounts of blood every few weeks due to bronchiectasis, but states that for the past two days he has been vomiting up blood. The patient has also had several “dark” bowel movements. Past medical history is significant for bronchiectasis and pulmonary embolism. Current medications include albuterol, apixaban, and an iron supplement. Temperature is 37 ºC (98.6 ºF), pulse is 120/min, blood pressure is 72/51, respiratory rate is 16/min, and SpO2 is 100% on room air. The patient appears pale, and the rectal examination is negative for melena but positive for bright red blood. Serum hemoglobin is 5.9 g/dL. Which of the following is the best next step in management?  

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