Peptic ulcers, gastritis, and duodenitis (pediatrics) Quiz: Ace Your Exams
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A 7-year-old boy is brought to the emergency department by his parents with hematemesis and severe epigastric pain for the past 10 hours. The child had been experiencing intermittent abdominal pain and occasional nausea for the past two weeks, but medical attention was not sought. Earlier today, a large amount of blood was noted in the vomitus, prompting the parents to seek care. The child has no significant past medical history. The only medication taken is ibuprofen for a sprained ankle that occurred 10 days ago. Temperature is 36.7°C (98.1°F), heart rate is 150/min, blood pressure is 70/40 mmHg, respiratory rate is 26/min, and oxygen saturation is 99% on room air. The child appears pale and lethargic. Abdominal examination reveals tenderness localized to the epigastric region without rebound or guarding. The abdomen is soft. Tachycardia and a 2/6 flow murmur are appreciated at the left sternal border. Capillary refill is three seconds. What is the most appropriate initial management?
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