Nremt Paramedic Level Question of the Day

Practice Nremt Paramedic Level with the production-style question-of-the-day selection for this public URL.

Question 1

A 78-year-old male taking apixaban for atrial fibrillation presents with weakness and dizziness. He reports his stool has been black and tarry for two days. This morning, he passed a large amount of maroon-colored stool. Vital signs are: BP 92/58 mmHg, HR 118 bpm, RR 22 breaths/min.

What does the recent change from melena to maroon-colored stool most likely indicate?

The development of a second, distinct lower GI bleed in addition to the upper GI bleed.
A rapid intestinal transit time due to a massive, ongoing upper GI hemorrhage.
Bleeding from hemorrhoids caused by straining from the initial upper GI bleed.
A benign side effect of the anticoagulant medication causing stool discoloration.

Explanation: Melena (black, tarry stool) results from digested blood from an upper GI source. When an upper GI bleed becomes massive, the blood transits the bowel so quickly that it does not have time to be fully digested by bacteria and enzymes. This results in hematochezia (maroon or red stool) from an upper GI source, which indicates a very rapid and life-threatening rate of bleeding.

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Nremt Paramedic Level

Nremt Paramedic Level Question of the Day

Practice Nremt Paramedic Level with the production-style question-of-the-day selection for this public URL.

Question 1

A 78-year-old male taking apixaban for atrial fibrillation presents with weakness and dizziness. He reports his stool has been black and tarry for two days. This morning, he passed a large amount of maroon-colored stool. Vital signs are: BP 92/58 mmHg, HR 118 bpm, RR 22 breaths/min.

What does the recent change from melena to maroon-colored stool most likely indicate?

The development of a second, distinct lower GI bleed in addition to the upper GI bleed.
A rapid intestinal transit time due to a massive, ongoing upper GI hemorrhage.
Bleeding from hemorrhoids caused by straining from the initial upper GI bleed.
A benign side effect of the anticoagulant medication causing stool discoloration.

Explanation: Melena (black, tarry stool) results from digested blood from an upper GI source. When an upper GI bleed becomes massive, the blood transits the bowel so quickly that it does not have time to be fully digested by bacteria and enzymes. This results in hematochezia (maroon or red stool) from an upper GI source, which indicates a very rapid and life-threatening rate of bleeding.