A 60-year-old man is admitted to the emergency department (ED) with a report of vomiting bright red blood

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A 60-year-old man is admitted to the emergency department (ED) with a report of vomiting bright red blood. He has had liver cirrhosis for the past 10 years and states that he has been drinking heavily since his wife died last year. His blood pressure is 106/68, and his pulse rate is 94. His abdomen is distended, and he is having some difficulty breathing; his respirations are 34 per minute. You are assigned to care for this patient.

 

  1.   For what complications is this patient at risk and why? What causes these complications?

  2.   In what position will you place the patient and why? What evidence supports your answer? Why do you think he has tachypnea?

  3.   The physician suspects that he has bleeding gastroesophageal varices. What laboratory tests will he likely request and why?

  4.   Vasopressin is prescribed for the patient, and several large-bore IV lines are inserted. What is the purpose of this drug for this patient?

  5.   How will you know if the drug was effective?

  6.   If the drug is not effective in treating the patient, what other options are available for his management?