Emergency Medical Technician (EMT) Intermediate Practice Exam

What condition should you be MOST suspicious of in an unconscious patient with signs of shock and hematochezia?

1. Upper gastrointestinal bleeding

2. Lower gastrointestinal bleeding

3. Abdominal aortic aneurysm

4. Concussion

The correct answer is: Lower gastrointestinal bleeding

In a scenario where an unconscious patient presents with signs of shock and hematochezia, the presence of hematochezia, which is the passage of fresh blood through the anus, indicates bleeding from the lower gastrointestinal tract. This symptom, combined with shock, suggests a significant volume of blood loss, which is often associated with lower gastrointestinal bleeding. Lower gastrointestinal bleeding can stem from various causes, such as diverticulosis, colorectal cancer, ischemic colitis, or inflammatory bowel disease, among others. The urgency of assessing and managing this condition is heightened due to the potential for rapid deterioration in the patient's hemodynamic status. While upper gastrointestinal bleeding may also cause hematochezia in certain situations, it more typically presents with melena—dark, tar-like stools—due to the digestion of blood as it passes through the gastrointestinal tract. An abdominal aortic aneurysm could lead to shock but is more commonly associated with back pain and, potentially, abdominal pain rather than hematochezia. Additionally, a concussion does not relate to gastrointestinal bleeding and would not explain the blood loss or shock state effectively. Understanding these points emphasizes the critical connection between the signs presented and the diagnosis of lower gastrointestinal bleeding as the most probable condition.