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

In this scenario, the clinical presentation of a 21-year-old man who has vomited blood after severe retching is concerning for several potential diagnoses, particularly hematemesis due to mucosal injury like a Mallory-Weiss tear or other gastrointestinal bleeding. Given the severity of vomiting blood, it is critical to ensure patient safety and monitor for any complications related to the bleeding.

Admitting the patient for 24-hour observation is a prudent approach, particularly when considering the possibility of ongoing bleeding or the development of more serious complications. This level of observation allows for continuous assessment of the patient’s vital signs, hemoglobin levels, and any signs of hemodynamic instability. It also provides an opportunity to initiate further diagnostic investigations and appropriate intervention if the patient's condition worsens.

The option for urgent gastroscopy is typically reserved for patients who present with more severe symptoms, such as active gastrointestinal bleeding, hemodynamic instability, or signs of significant anemia. Although the patient has vomited blood, the immediate need for endoscopic intervention might not be indicated without evidence of continued bleeding or other alarming clinical features.

Discharging the patient with reassurance would not be safe in this context, given the potential severity of the symptoms. Similarly, referring for outpatient gastroscopy does not provide