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학습 자료 둘러보기 →In a cirrhotic patient, coffee-ground emesis is a hallmark of upper gastrointestinal bleeding, most commonly from esophageal varices. The presence of hypotension (e.g., SBP <90 mm Hg) and tachycardia (HR >100 bpm) confirms progression to hypovolemic shock, demanding immediate intervention to restore circulatory volume and protect the airway.
Apply the ABC framework: active hemorrhage with hemodynamic instability is a 'C' (Circulation) priority that also threatens 'A' (Airway) due to aspiration risk. Initial actions include securing large-bore IV access, initiating fluid resuscitation, and preparing for blood transfusion and vasoactive drugs (e.g., octreotide).
Do not delay intervention to treat hepatic encephalopathy or ascites. Altered mental status in this context may be due to cerebral hypoperfusion from shock, not just hyperammonemia. Airway protection via endotracheal intubation is critical before endoscopic intervention if the patient has massive hematemesis or a depressed level of consciousness.
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