American College of Gastroenterology recommendations for initial assessment and risk stratification for patients with ulcer bleeding include which of the following?
a. Hemodynamic status should be assessed immediately on presentation and resuscitative measures begun as needed.
b. Blood transfusions should target hemoglobin 7 g/dL or greater, with higher hemoglobin levels targeted in patients with clinical evidence of intravascular volume depletion or comorbidities.
c. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions, such as timing of endoscopy, time of discharge, and level of care.
d. A, B, and C
The first step in management of patients who present with overt upper GI bleeding is assessment of hemodynamic status and initiation of resuscitative measures as needed. In addition to intravenous fluids, transfusion of red blood cells may be required. Risk assessment is clinically useful to determine which patients are at higher risk for further bleeding or death.