A 45-year-old man with a known history of peptic ulcer disease presents with coffee-ground emesis and lightheadedness. He appears pale and his heart rate is 110 bpm. What are the potential diagnoses and next steps?
This patient is showing signs of an upper gastrointestinal bleed likely due to a bleeding peptic ulcer, as suggested by coffee-ground emesis, signs of shock (elevated heart rate, lightheadedness), and pallor. Initial management should focus on hemodynamic stabilization, starting intravenous fluids, and possibly blood transfusion depending on the severity of bleeding. Proton pump inhibitors should be given intravenously, and emergent gastroenterology consultation for endoscopic evaluation and possible intervention should be obtained.