What is the priority intervention if a patient cannot be discharged after a hip replacement due to sudden gastric bleeding?

What is the priority intervention if a patient cannot be discharged after a hip replacement due to sudden gastric bleeding?

• A. Sengesten-Blakemore tube insertion
• B. An intravenous bolus of normal saline
• C. Administration of oxygen
• D. Insertion of a nasogastric tube and saline lavage

Answer: (D)

When a patient has sudden upper GI bleeding, the top priority is to control the stomach’s contents and prepare for definitive assessment and treatment. Inserting a nasogastric tube with saline lavage directly addresses the bleeding site by decompressing the stomach, removing blood and clots, and allowing lavage to clear the field for accurate assessment and subsequent endoscopy. This also reduces the risk of aspiration if the patient is unstable or needs transfer for invasive procedures. The other options don’t address the bleeding as directly. A Sengesten-Blakemore tube is used for certain massive esophageal variceal bleeds and is not first-line for a gastric bleed. An IV fluid bolus helps with volume status but doesn’t control the source of bleeding. Oxygen provides support but again does not manage the bleeding itself. Therefore, the nasogastric tube with saline lavage is the most immediate, targeted intervention.

When a patient has sudden upper GI bleeding, the top priority is to control the stomach’s contents and prepare for definitive assessment and treatment. Inserting a nasogastric tube with saline lavage directly addresses the bleeding site by decompressing the stomach, removing blood and clots, and allowing lavage to clear the field for accurate assessment and subsequent endoscopy. This also reduces the risk of aspiration if the patient is unstable or needs transfer for invasive procedures.

The other options don’t address the bleeding as directly. A Sengesten-Blakemore tube is used for certain massive esophageal variceal bleeds and is not first-line for a gastric bleed. An IV fluid bolus helps with volume status but doesn’t control the source of bleeding. Oxygen provides support but again does not manage the bleeding itself. Therefore, the nasogastric tube with saline lavage is the most immediate, targeted intervention.