ABSTRACT
This chapter presents a case study of a 65-year-old man who is brought in as a 'priority call' to the Emergency Department after he fainted at home. The patient presents what appears to be lower gastrointestinal (GI) bleeding, as evidenced by fresh blood in his stools and the presence of clots on rectal examination. He is tachycardic and hypotensive, and also has an elevated INR. He should be acutely managed in the resuscitation room as he is unstable; management should proceed along the 'ABCDE' approach, with delivery of supplemental oxygen and establishment of intravenous access with two large-bore cannulae. One of the key aspects of managing this patient's blood is addressing his coagulopathy. Management of a supratherapeutic INR depends upon two factors: the extent of INR elevation and the presence or absence of bleeding. In the presence of serious or life-threatening bleeding, complete reversal is required within a short period of time.
