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A 65-year-old man was admitted to the ICU for bright red blood per rectum and hemorrhagic shock. He has a history of abdominal aortic aneurysm for which he underwent endovascular aneurysm repair 2 years ago. He is intubated and sedated on mechanical ventilation. He has received 6 units packed RBCs, 6 units fresh frozen plasma, 5 units platelets, and 2 units cryoprecipitate. His corrected calcium is 10 mg/dL, and he is normothermic with pH 7.35 and lactate level 4 mg/dL on his most recent blood gas analysis. He continues to have bright red blood per rectum. A nasogastric tube is placed with non-bloody return. Which of the following is the most appropriate next step? A. Gastrointestinal consultation for endoscopy B. Surgical consultation C. IV proton pump inhibitor D. IV octreotide
Sagot :
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