CASE 005 · Emergency Department · Advanced · 10–14 min
The Patient Who Is Vomiting Blood
· Patient arriving
58-year-old male — “I threw up blood this morning.”
9:47 PM — walks in pale and sweaty, holding an emesis basin. Two episodes of coffee-ground vomit today; the last one turned bright red.
BP 96/64HR 118RR 22SpO₂ 97% RATemp 98.0°F
You do not get the diagnosis. You get the patient. Reason your way there.
What SHOULD be happening?A — Assess Normal
Stomach acid digests food — never the stomach itselfMucus + bicarbonate + prostaglandins shield the liningVessels stay sealed; blood volume stays constantHemoglobin carries oxygen at full strengthThe gut and the circulation never meet directly
Somewhere the shield failed, acid reached an artery, and his circulation is now draining into his own gut. The vital signs will tell the story long before the lab does.
RUN IT · ACTIVEThis patient deteriorates while you work. Time matters.
MaldekChin cases are for healthcare education and clinical-reasoning training. They do not replace local protocols, faculty instruction, clinical supervision, or professional judgment.