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학습 자료 둘러보기 →The immediate priority in a patient with cirrhosis and active upper GI bleeding is to manage hypovolemic shock. The first action is to establish large-bore IV access and begin fluid resuscitation with crystalloids to restore intravascular volume and tissue perfusion before definitive bleeding control.
Administer vasoactive drugs like octreotide and prepare for endoscopy only after initial hemodynamic stabilization. The goal is to maintain a systolic blood pressure of 90-100 mmHg and a heart rate below 100 bpm.
Avoid over-aggressive volume resuscitation with normal saline as it can worsen ascites and precipitate rebleeding. Use a restrictive transfusion strategy targeting a hemoglobin of 7-8 g/dL. Do not insert a nasogastric tube due to the risk of rupturing esophageal varices.
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