Which option best describes the initial priority in a patient with hematemesis and hypotension?

• A. Emergent surgery
• B. Administer IV fluids and blood products as needed
• C. Hemodynamic stabilization with IV fluids and blood products as needed, followed by urgent endoscopic evaluation
• D. Obtain CT scan of the abdomen

Answer: (C)

In an unstable patient with hematemesis, the first priority is to restore circulating volume and perfusion. This means starting aggressive resuscitation with intravenous fluids and transfusion of blood products as needed, while monitoring vital signs and preparing for rapid crossmatching. Once the patient’s hemodynamics are stabilized, urgent endoscopic evaluation is performed to identify the bleeding source and provide therapeutic measures (such as clipping, cautery, or injections) to control the bleed.

Imaging like a CT scan of the abdomen doesn’t address the immediate life-threatening need to restore perfusion in an unstable patient, and emergent surgery is reserved for situations where bleeding cannot be controlled endoscopically or the patient remains unstable despite resuscitation. So the best course is stabilization with IV fluids and blood products, followed by urgent endoscopy.