First Things First (assess for & treat the following)

• Upper GI bleed (UGIB), proximal to ligament of Treitz (LT); lower GI bleed (LGIB), distal to LT

• Airway protection
  • Consider endotracheal intubation in a pt w/ massive UGI bleeding, especially if he/she has altered mental status; massive bleeds are more commonly seen in variceal bleeding.
• Circulation
  • Assess hemodynamic status and intravascular volume (i.e., orthostatic, tachycardia, cool-clammy skin, etc.)
    • Hypotension is a late finding in shock. Never underestimate the magnitude of the GI blood loss.
  • Establish two large-bore peripheral lines, or central access if unable to obtain adequate peripheral access.
    • Resuscitate using crystalloids, blood and its components with correction of coagulopathy.