What is the most appropriate next step in management for a 21-year-old man who vomited blood after severe retching?

In the case of a 21-year-old man who has vomited blood following severe retching, the most appropriate next step in management is to admit him for 24-hour observation. This is due to several important considerations.

Vomiting blood, especially when associated with retching, raises concern for potential underlying conditions such as mucosal tears (like Mallory-Weiss syndrome), gastrointestinal bleeding, or even esophageal varices. Given the young age of the patient and the acute nature of the symptom (hematemesis), it is critical to monitor for any signs of ongoing bleeding or hemodynamic instability that could develop.

Admitting the patient allows for adequate supportive care, including monitoring vital signs, possibly administering intravenous fluids, and assessing the patient's overall condition. The observation period provides an opportunity for the healthcare team to gather more information regarding the patient's status – for instance, checking hemoglobin levels to see if there has been any significant loss of blood.

In contrast, urgent gastroscopy might seem like a reasonable option, but it is typically reserved for patients who are unstable or exhibiting signs of significant bleeding. In this scenario, observation can often provide important insights before such an invasive procedure is necessary.

Discharging the patient with reassurance would not be appropriate because