Amaia, a 16-Year-Old Girl with Hematemesis

CASE PRESENTATION Amaia is a 16-year-old girl who presented to the emergency department (ED) earlier today with 2 days of forceful vomiting. Her emesis has become bloody today. In the ED, she appears dehydrated and has several witnessed episodes of bright red emesis that are guaiac positive. The ED physician caring for her obtains intravenous (IV) access and draws blood for laboratory tests, including a complete blood cell count (CBC), comprehensive metabolic panel, prothrombin time (PT)/international normalized ratio (INR), partial thromboplastin time (PTT), urine pregnancy test, and blood type and crossmatch. The ED physician also gives Amaia a 20-mL/kg normal saline bolus and IV doses of ondansetron and a proton pump inhibitor (PPI). Amaia’s laboratory test results are significant for a hemoglobin level of 8.8 g/dL (88 g/L), and the ED physician contacts you to evaluate Amaia for admission.