Upper GI Bleed

• Resuscitate first: 2 large-bore IVs, type & cross; transfuse restrictively (Hb 70 g/L threshold when stable; major hemorrhage needs immediate protocol-based resuscitation).
• Consider erythromycin 250 mg IV before endoscopy for severe/ongoing bleeding (check QT); after hemostasis of high-risk ulcer stigmata, give high-dose PPI continuously or intermittently for 72 h.
• Scope after resuscitation: nonvariceal within 24 h; sooner if instability persists despite adequate resuscitation. Suspected variceal bleeding: within 12 h, plus vasoactive therapy, ceftriaxone and variceal hemostasis.
• Rockall/Blatchford scores stratify risk; reverse anticoagulation judiciously.
• Reverse DOACs specifically when bleeding is life-threatening (idarucizumab for dabigatran, selected off-label 4-factor PCC 50 U/kg for Xa inhibitors — andexanet was withdrawn in the US in 2025); 4-factor PCC for warfarin.

First tests: Full blood count, Blood group and crossmatch, Sodium, potassium, bicarbonate, urea and creatinine, PT/INR and aPTT, Liver biochemistry, Upper GI endoscopy.

Only if indicated: Blood lactate, H. pylori testing.

Repeat monitoring: Full blood count.

• First Steps in Acute Gastrointestinal (GI) Bleeding
• Managing Acute Upper Gastrointestinal (GI) Bleeding
• Managing Peptic Ulcers