Resuscitate first, localize upper versus lower second, and time endoscopy correctly.
Variceal hemorrhage
Cirrhotic + massive hematemesis — antibiotics + splanchnic vasoconstrictor + urgent endoscopy.
Brisk arterial ulcer bleed
Hypotension with fresh hematemesis — activate massive transfusion.
Aortoenteric fistula
Prior aortic graft + GI bleed = immediate vascular imaging.
Melena usually means an upper source — but red blood with shock can still be a brisk upper bleed.
Score with Glasgow-Blatchford: zero = candidate for outpatient management.
Two lines, measured fluids, rapid transport — no time wasted on fine titration.
NSAID or dyspepsia history; the commonest upper cause.
Known cirrhosis, ascites, jaundice.
Fresh blood without hematemesis, elderly.
Blood streaks after repeated violent vomiting.
Info
The bleeding anticoagulated patient: the question is not whether to reverse but how fast — consult and activate the local reversal protocol.
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This content is an educational reference and does not replace clinical judgement or local protocols.
