Minimal Bleeding Benign Cause Likely
Observe, PO challenge No labs Reassuring VS, physical exam PCP follow-up

Concern for Significant Blood Loss
Evaluation	Consider work-up for anemia, coagulopathy NPO, IV Access Laboratory Considerations Consider Imaging GI Consult
Treatment	IVF as indicated Medications as indicated Pantoprazole IV Sheffield Score
Reassessment	Assess MS, perfusion, VS q30 min until stable Monitor Response to Treatment Repeat CBC in 4 hrs as indicated Monitor ongoing blood loss Consider Sump Placement, lavage w/ GI
Disposition	Review w/ GI indications for admission vs. discharge with follow-up

Active Bleeding
Evaluation	Expedited work-up for anemia, coagulopathy NPO, IV access x 2 IV Escalation Plan Laboratory Considerations Consider Imaging GI and Surgery Consult
Treatment	Initial IVF Rapid infusion of NS or LR 20 mL/kg Transfuse PRBCs High Dose Pantoprazole IV Consider Massive Transfusion Procedure Anticoagulation Management Medications Consider Sump Placement, lavage w/ GI Consider Octreotide, review w/ GI, PICU Sheffield Score
Reassessment	Assess MS, perfusion, VS q15 min Monitor Response to Treatment Repeat CBC in 4 hours Monitor ongoing blood loss
Disposition	PICU Review with GI, PICU