USMLE® Step 2 CK
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A 60-year-old man with a history of alcohol abuse is brought to the emergency department because of hematemesis, which began suddenly at home 1 hour ago. He denies abdominal pain, hematochezia, and melena. His pulse is 110/min, respirations are 19/min, and blood pressure is 100/60 mm Hg. Physical examination shows multiple spider angiomata on his back and chest. He has bilateral gynecomastia. Abdominal examination shows a distended abdomen which is tympanic on percussion and hepatosplenomegaly. His testicles are small, and a rectal examination produces guaiac-negative stool. His hematocrit is 23%. After placement of a nasogastric tube, 400 mL of bright red blood is evacuated. After initial fluid resuscitation, which of the following is the most appropriate next step in management?