Gastrointestinal BleedingICU / resuscitation

Two episodes of haematemesis and melaena since morning; HR 118, BP 92/60; on aspirin and ibuprofen (or known cirrhosis)

• Shock index >1
• Haematemesis with instability
• Rebleeding
• Encephalopathy in cirrhosis

• Peptic ulcer
• Oesophageal/gastric varices
• Mallory–Weiss tear
• Erosive oesophagitis/gastritis
• Malignancy
• Aorto-enteric fistula (previous AAA graft)

• Admit: All except Glasgow-Blatchford 0–1
• ICU: Shock, ongoing bleeding, variceal bleed, rebleed, need for airway protection
• Intubate: Massive haematemesis, GCS low, before endoscopy in active variceal bleeding with encephalopathy
• Transfuse: Hb <70 g/L (restrictive), <80 g/L with cardiovascular disease; massive haemorrhage protocol if unstable
• Vasopressors: Only as a bridge — haemostasis and blood come first

• Variceal bleeding: vasoactive drug + antibiotic + band ligation within 12 h — the triad that saves lives.
• Continuing aspirin for secondary prevention after ulcer bleeding reduces mortality, even though rebleeding rises slightly.
• Lower GI bleed with shock: CT angiography first; most stop spontaneously; colonoscopy after bowel prep in stable patients.

• Give tranexamic acid for GI bleeding (HALT-IT: no benefit, more VTE and seizures)
• Over-transfuse a variceal bleed (raises portal pressure)
• Forget antibiotics in a cirrhotic GI bleed
• Leave NSAIDs on the discharge chart

• Under-resuscitation or over-transfusion
• Missing varices (no terlipressin or antibiotics)
• Delaying endoscopy >24 h
• Tranexamic acid

Endoscopy within 24 h; ICU for instability or variceal bleeding; follow-up scope for gastric ulcers at 6–8 weeks.