An 89-year-old male from a nursing home arrives in the ED with bright red rectal bleeding—a classic emergency with a not-so-straightforward twist. What starts as a presumed lower GI bleed quickly becomes a complex balancing act: anticoagulants, aortic aneurysm history, and lab abnormalities all collide. In this episode, we unpack how comorbidities and high-risk medications can obscure the clinical path, and how interdisciplinary teams tackle the fine line between preventing clots and stopping a hemorrhage. This case is a goldmine for learners looking to sharpen their skills in medication reconciliation, fluid management, and GI emergency triage.

Key Topics for Clinical Learning:

• Lower GI Bleed Triage in the Elderly
  → What bright red blood per rectum tells us—and what it doesn’t.

• Diagnostic Imaging & Aortic Aneurysm History
  → How CT angiography helped rule out active aneurysm leakage while pointing to a distal sigmoid source.

• Anticoagulation Crossroads
  → Managing patients on Plavix and Xarelto during acute bleeding: who decides, and how?

• Electrolyte Red Flags
  → Elevated calcium and magnesium: underlying cause or consequence of fluid shifts and comorbidities?

• Interdisciplinary Decision-Making
  → Involving GI, cardiology, and pharmacy to coordinate care in a frail, medically complex patient.