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A 70-year-old man with cirrhosis vomits bright red blood twice and is lightheaded. Blood pressure is 88/54, heart rate is 124/min, and he has melena. Two large-bore IVs are placed. Which immediate management is most appropriate?
Oral proton-pump inhibitor and next-week endoscopy
Resuscitate and start octreotide with urgent endoscopy consultation
Nasogastric lavage as definitive therapy
Hold all blood products until hemoglobin is below 5 g/dL
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