MedBalans

GI Bleeding (Emergency)

Adults · emergency only · brief protocol

Algorithm

  1. ABC; large-bore IV ×2; continuous monitoring; estimate blood loss; protect airway if massive hematemesis / low GCS.
  2. Resuscitate with crystalloid then balanced transfusion strategy; activate massive hemorrhage protocol if unstable; correct coagulopathy (including anticoagulant reversal).
  3. Urgent bloods: CBC, coagulation, group & crossmatch, lactate, renal/liver panel; ECG if elderly / ACS risk.
  4. Proton pump inhibitor IV for suspected non-variceal upper GI bleed — do not delay resuscitation/endoscopy.
  5. If cirrhosis / suspected variceal bleed: antibiotics (e.g. ceftriaxone), vasoactive drug (terlipressin/octreotide per protocol), early endoscopy.
  6. Urgent gastroenterology / endoscopy for unstable or high-risk bleed; CT angiography ± IR embolization / surgery if lower GI or endoscopy fails.

Red flags

  • • Hemorrhagic shock / massive transfusion need
  • • Variceal bleed in cirrhosis
  • • Anticoagulants — need reversal
  • • Concomitant myocardial ischemia

Medications by step

Acid suppression / support

  • Pantoprazole / omeprazole · i.v.

    80 mg IV bolus then infusion or intermittent high-dose per local protocol

  • RBC transfusion · i.v.

    Restrictive target often Hb ~70–80 g/L if stable; higher if ACS/shock

Suspected variceal

  • Terlipressin · i.v.

    Per local protocol (e.g. 2 mg IV q4–6 h initially)

  • Ceftriaxone · i.v.

    1–2 g IV daily (cirrhosis + GI bleed)

References

  • • ESGE — Non-variceal upper GI bleeding (2021)
  • • Baveno / EASL — Variceal bleeding principles (2022)

Updated: Июль 2026