Juanita Rapidita, a 45 y.o. Hispanic female is walked into the ED by the triage nurse with a complaint of palpitations. Patient speaks only Spanish, but you obtain, with your limited spanglish, a history that the patient feels a bit dizzy ("mareado"), she denies LOC, no nausea, vomiting, shortness of breath or chest pain. She reports that she has felt this way since riding the "6" to work this a.m. -- the air wasn't working,so instead of going to work she came into the ED.

Physical Exam reveals a well developed and well nourished HF, alert on stretcher. HR is 190, BP 110/70 rr18, temp 99.9, Sat. 97%RA. HEENT reveals no JVD, no bruits. Lungs are clear, heart is tachy and regular. Extremities show no edema.

A better history was obtained and it was determined that the patient had been feeling weak and dizzy over the last few days. On review of systems it was discovered that the patient has been having melenotic stools over the last 2 days. Rectal was performed and it was heme positive black stool. The patient was admitted with HCT. of 32. Repeat Hct. on the floor was 24. She was transferred to the ICU, immediately endoscoped, but during the endoscopy she coded, but survived and received 6 units of blood.