Live-threatening bleeding - 2014

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52 year old male, accompanied by his wife, attends his general practitioner with the complain of vomiting blood. His clothes are soaked with blood, he is confused and pale. According to his wife, the husband vomited a large amount of bright red blood in the last 2 hours. He has never had a problem like this before. Denies high temperature or shivering. The man neither takes any medication regularly, nor was he treated for any chronic disease. He has a history of chronic alcoholism. What will be the GP´s next step?

Vomiting blood may indicate a serious condition and the GP is first trying to determine the amount of vomited blood and circumstances around the vomiting. Then he makes an assessment of consciousness, measures blood pressure, pulse (heart rate) and respiratory rate. He focuses on auscultation of chest and palpation of the abdomen.

Correct answer

Evaluation of the history and physical examination are essential for diagnosis and further therapeutic procedures.


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Vomiting blood is related to alcohol ingestion. The GP recommends the patient a therapy for alcohol abuse.

Wrong answer

Regular healthy checks should be performed with the GP to make an early detection of alcohol abuse organ damage and advise the patient about possibility of alcohol abuse therapy. At this time the history and examination of the patient takes the first place.


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He is carrying out an examination of consciousness, measures blood pressure, pulse (heart rate) and respiratory rate. He examines breathing by auscultation of chest and palpates abdomen. To prevent further womiting he prescribes prokinetics metoclopramide IV (eg Cerucal 10 mg inj. sol.).

Wrong answer

Stimulation of gastrointestinal motility in connection with blood vomiting is not desirable and possibly dangerous to the patient. Prokinetics are therefore contraindicated in gastrointestinal bleeding.


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