1. The first step is IV fluid of Ringer Lactate or Normal Saline resuscitation using large bore cannula
  2. Check out A,B,C (Airway, breathing, Circulation, Temperature, blood pressure, pulse rate, etc)
  3. Send the blood sample for CBC, PT, and in case cross match.
  4. Find out any Liver abnormality, stigmata, hepatosplenomegaly, or decompromised cirrhosis.
  5. If PT is elevated, immediately start Fresh Frozen plasma. Vitamin K work too slowly in this regard, so less effective.
  6. Octreotide is added in treatment to control portal hypertension and developing cirrhosis.
  7. Naso-gastric tubing, which is used first for diagnostic purpose can be helpful for therapeutic purpose too e.g. in putting saline solution into the bleeding site.
  8. Endoscopy is used only for finding out etiology of disease.
  9. Though in more than 85% of patients, spontaneous bleeding resolve by itself, yet Proton Pump Inhibitors and H2- receptor blockers add effectiveness to the treatment plane.
  10. Sclerotherapy, emergency endoscopy and TIPS (Trans-jugular Intra hepatic Porto-systemic Shunting) are the surgical techniques to stop bleeding.
  11. Black-more Tube to temponade the site of bleeding in stomach or esophagus is rarely used now a days.
  12. Beta blockers, propronol is however gaining more and more space in stooping bleeding from varicose.