The patient is exsanguinating. The fastest way to control the bleeding is to insert a Blakemore tube to tamponade the bleeding gastric varices, thus markedly slowing or stopping the blood loss. TIPS placement is effective for treating portal hypertension, but the procedure has an unacceptably high mortality rate in actively bleeding, unstable patients. Octreotide administration can slow blood flow to the varices but would take too long to act in this patients situation. Propranolol can be used to treat portal hypertension, but it is contraindicated in bleeding patients. Surgery could result in definitive treatment via the creation of a decompressing shunt, but the patient needs urgent stabilization.
- Insertion of a Blakemore tube.
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