The principles and practices of volume resuscitation apply to patients with variceal bleeding but will not be explicated in this article. There are additional practical points to be made. The patient's baseline weight and an estimation of ascites are needed. Overtransfusion should be avoided because it can exacerbate ascites, impair mechanical ventilation efforts, and increase portal pressures. The latter may increase the risk for rebleeding.
Endotracheal intubation is most critical before emergency endoscopy.
The value of aggressive airway protection is immeasurable. In the management of variceal bleeding, the main goal is to control the bleeding expeditiously while keeping the patient's stay in the hospital as short as possible and keeping morbidity to a minimum. An endoscopic examination is critical for determining the diagnosis, directing the management of the disease, and providing therapy. If endoscopy is unavailable, the clinician must act on a presumptive diagnosis based on a history of known liver disease or other conditions giving rise to portal hypertension, especially if the acute bleeding is accompanied by hematemesis. Endoscopy should be performed promptly once signs of stabilization are evident during resuscitation.