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Vomiting Blood (Hematemesis): Causes, Emergency Steps & Medical Evaluation

Vomiting blood (hematemesis) is a medical emergency. It indicates active upper GI bleeding (esophagus, stomach, duodenum). Call 911 or go to the nearest ER immediately. Do not drive yourself.

Immediate Actions While Seeking Help

  1. Call 911 / Go to ER. This is the single most important step.
  2. Position: Sit upright or lie on left side with head elevated. If faint/dizzy, lie flat with legs raised (Trendelenburg) to maintain cerebral perfusion.
  3. Do NOT eat or drink. Keep stomach empty for endoscopy. Small sips of water only if extremely thirsty and not nauseated.
  4. Do NOT take medications. Especially NSAIDs (ibuprofen, aspirin), anticoagulants, or herbal supplements—these worsen bleeding.
  5. Collect sample if possible: Save a small amount in a container for the medical team (helps identify source: bright red = active arterial; coffee-ground = slowed/partial digestion).
  6. Stay calm: Anxiety increases heart rate and bleeding. Slow, deep breaths.

Common Causes

SourceConditions
EsophagusVarices (cirrhosis), Mallory-Weiss tear (retching), Esophagitis, Cancer
StomachPeptic Ulcer Disease (H. pylori, NSAIDs), Gastritis, Dieulafoy lesion, Cancer, Angiodysplasia
DuodenumUlcer (most common overall cause), Vascular malformation
VascularAorto-enteric fistula (rare, post-graft), Hemosuccus pancreaticus

Hospital Evaluation & Treatment

  1. Resuscitation: IV access (2 large-bore), fluids, blood transfusion if Hb <7–8 g/dL or unstable.
  2. PPI IV bolus + infusion (e.g., Pantoprazole 80mg bolus then 8mg/hr) – stabilizes clot.
  3. Urgent Upper Endoscopy (EGD) within 24h: Diagnose + treat (clips, cautery, banding, injection, hemostatic powder).
  4. Adjuncts: Octreotide (varices), Antibiotics (cirrhosis), Tranexamic acid (controversial).
  5. Interventional Radiology/Surgery if endoscopy fails.

Red Flags for Mortality Risk (Glasgow-Blatchford / Rockall Scores)

  • Hemodynamic instability (SBP <90, HR >100)
  • Comorbidities (liver, heart, kidney disease, cancer)
  • Age >60
  • Syncope, melena, syncope
  • Re-bleeding after initial control

Never "wait and see." Hematemesis can progress to exsanguination rapidly. Emergency care is non-negotiable.

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