Approach to melena and hematemesis (pediatrics) Quiz: Ace Your Exams
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A 9-year-old girl presents to the emergency department for evaluation of nausea, fatigue, forceful vomiting, and abdominal pain for 3 days. The child experienced an episode of hematemesis that morning and was brought in by her parents. She has not had fever, black stools, diarrhea, or mucous in stools. Family and past medical history are non-contributory. Temperature is 36.5 °C (97.7 °F), pulse is 135/min, respirations are 18/min, blood pressure is 87/46 mm Hg, and oxygen saturation is 95% on room air. On physical exam, the patient is lethargic and pale. Abdominal exam reveals epigastric tenderness without distention, rebound, guarding or rigidity. Cardiopulmonary exam is unremarkable. Which of the following is the most appropriate next step in management?
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