Gastrointestinal bleeding
Upper: hematemesis of bright red blood or coffee-ground material, melena (black tarry stool), rising urea with normal creatinine because blood is digested as protein. Lower: bright red blood per rectum, hematochezia. Cirrhosis with varices bleeds fast and massively. Priorities: large-bore IV access times two, type and screen, fluids, monitor, keep NPO, position on the side if vomiting, and watch for compensated shock before the blood pressure falls.