Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate?
A. He has fresh, active upper GI bleeding.
B. He needs immediate saline gastric lavage.
C. His gastric bleeding occurred 2 hours earlier.
D. He needs a transfusion of packed RBCs.
Correct Answer: C. His gastric bleeding occurred 2 hours earlier.
Coffee-ground emesis occurs when there is upper GI bleeding that has undergone gastric digestion. For blood to appear as coffee-ground emesis, it would have to be digested for approximately 2 hours. The term “coffee-grounds” describes gastric aspirate or vomitus that contains dark specks of old blood. UGIB is classified as any blood loss from a gastrointestinal source above the ligament of Treitz.
Option A: The clinical presentation can vary but should be well-characterized. Hematemesis is the overt bleeding with vomiting of fresh blood or clots. Patients may also present with syncope or orthostatic hypotension if bleeding is severe enough to cause hemodynamic instability.
Option B: Patients must have a minimum of two large-bore peripheral access catheters (at least 18-gauge). Intravenous fluids should be administered to maintain adequate blood pressure and hemodynamic stability. If patients are not able to protect their airways or have ongoing severe hematemesis, elective endotracheal intubation is advised.
Option D: Blood transfusions should be given to target a hematocrit above 20%, with a hematocrit above 30% targeted in high-risk patients, such as the elderly and patients with coronary artery disease. There is no evidence that higher targets for hematocrit goals should be sought as that higher targets can even be deleterious.
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