Question

Your adult patient called for help after he began to vomit bright red blood. On arrival, the patient is found to be tachycardic and bleeding freely from his mouth. His respirations are shallow, and his skin is cool with a blood pressure is 68 systolic. His only history involves liver disease from chronic alcoholism. He denies drinking recently.

What should be the goal of your pre-hospital intervention with this patient after ensuring his airway and applying oxygen therapy?

A. Fluid resuscitation to maintain a systolic blood pressure of 80-90 systolic

B. Fluid resuscitation to maintain a blood pressure of at least 100 systolic

C. To control the hemorrhage with pharmacologic intervention

D. Maintaining a high blood oxygen saturation to continue perfusion at the cellular level

Answer 1

The goal in managing a patient vomiting blood with signs of hypovolemic shock is fluid resuscitation to maintain a systolic blood pressure between 80-90 mm Hg, enough to sustain vital organ perfusion without exacerbating the hemorrhage.

Step-by-step explanation:

The goal of your pre-hospital intervention for an adult patient with a history of liver disease from chronic alcoholism who is vomiting bright red blood should be fluid resuscitation to maintain a systolic blood pressure of 80-90 mm Hg. The patient is demonstrating signs of hypovolemic shock characterized by tachycardia, bleeding, shallow respirations, cool skin, and hypotension. Immediate administration of oxygen is important, but aggressive fluid resuscitation is also required to prevent circulatory shock and ensure sufficient blood flow and oxygen delivery to tissues.

Why a Systolic Blood Pressure of 80-90 mm Hg?

Keeping the systolic blood pressure in the range of 80-90 mm Hg is a balance between ensuring adequate organ perfusion and avoiding exacerbation of the bleed by raising the blood pressure too high. It may seem counterintuitive not to aim for a 'normal' blood pressure of at least 100 systolic, but in the case of a severe hemorrhage, it is a permissive hypotension strategy to minimize bleeding while still maintaining vital organ perfusion.