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177110 Surgery

A 25-year-old man is involved in an automobile accident with resultant injuries including bilateral closed femur fractures, left pulmonary contusion, and closed head injury. On post-injury day 4, significant upper gastrointestinal hemorrhage begins. Endoscopic examination reveals an area of confluent ulceration with bleeding in the gastric fundus. Endoscopic hemostasis fails. Appropriate immediate management includes:

ALavage of gastric contents with iced saline
BUrgent total gastrectomy
CSelective aerial infusion of vasopressin the left gastric aery
DInseion of Sangstaken-Blakemore balloon
Surgery
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