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Warning-sign checks

Bleeding esophageal varices: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    Call emergency services immediately if you vomit blood, pass black tar-like stool, or see a large amount of red or maroon blood in your stool.

    Do not drive yourself.

    Emergency help is also needed for:

    • Fainting, severe dizziness, or inability to stand
    • New confusion, extreme sleepiness, or difficulty waking
    • Trouble breathing, choking, or coughing blood after vomiting
    • Pale, cold, clammy skin or a very rapid heartbeat
    • Severe weakness with suspected internal bleeding

    Contact your usual care team promptly, but not necessarily through emergency services, for increasing abdominal swelling, worsening jaundice, new mild confusion, reduced urine output, persistent weakness after treatment, or side effects from preventive medicines.

    And for anyone, someone who:

    • is bleeding heavily and it will not stop with firm pressure
    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    While waiting for help, avoid food and drink because urgent endoscopy or airway treatment may be needed.

    If the person is unconscious but breathing, place them on their side if it is safe to do so.

    Do not give aspirin or anti-inflammatory pain medicines.

  3. 3

    Does any of this apply?

    Book an appointment

    Routine follow-up includes planned blood tests, liver assessment, medication review, and repeat endoscopy when recommended.

    Keep these appointments even if you have no symptoms, because varices are usually silent until they bleed.

Every sign above is quoted from the sofidex article on Bleeding esophageal varices. If you are not sure, err upward — it is always reasonable to be checked.