›First 5 minutes
›Escalate to resuscitation bay if unstable
›Systolic blood pressure less than 90 mmHg
›Altered mental status
›Monitoring
›Continuous pulse oximetry
›Cardiac monitor
›IV access
›Two large bore peripheral IVs
›IO access if IV failure and unstable
›Initial fluids
›Balanced crystalloid bolus 500 mL to 1 L
›Stop boluses if pulmonary edema signs
›Blood products local protocol dependent
›Activate massive transfusion if ongoing shock
›Early type specific or O negative if delay
Transfusion and hemostasis strategy
›Hemostasis strategy
›Restrictive transfusion target when stable
›Hemoglobin under 70 g/L transfuse typical
›Higher threshold with active ischemia local protocol dependent
›Platelet transfusion thresholds local protocol dependent
›Platelets under 50 x 10^9 per L with active bleeding
›Higher targets for procedures
›Anticoagulant reversal local protocol dependent
›Warfarin
›Vitamin K IV
›PCC dosing per INR
›Dabigatran
›Idarucizumab
›Hemodialysis option in severe renal failure
›Factor Xa inhibitors
›PCC option
›Andexanet availability local protocol dependent
›Diagnostic sequencing
›If unstable and ongoing bleeding
›CT angiography early
›IR consult early
›If stable
›Colonoscopy planning with GI
›Stool studies if colitis features
›If upper GI source possible
›Consider PPI IV
›Early EGD pathway
Therapeutics by suspected cause
›Therapeutics
›Suspected infectious colitis
›Sepsis bundle if shock
›Antibiotics based on syndrome local protocol dependent
›Suspected ischemic colitis
›IV fluids
›Broad spectrum antibiotics if moderate to severe disease local protocol dependent
›Suspected hemorrhoids or fissure
›Topical analgesia local protocol dependent
›Stool softening strategy local protocol dependent
›Reassessment loop
›Vital signs frequency
›Every 5 to 15 minutes if unstable
›Every 30 to 60 minutes if stable
›Bleeding monitoring
›Stool count and appearance
›Ongoing clots
›Repeat labs timing
›Hemoglobin repeat in 4 to 6 hours if ongoing bleeding
›Earlier repeat if deterioration