Hemorrhage caused by esophagogastric fundic varices in cirrhosis is a clinical emergency due to high pressure and large bleeding volume, which is a technical and psychological challenge for us doctors. When you are on duty when such a patient comes, first of all, you should be heavy and calm, organized, not panic, as long as you can give full play to the knowledge and experience you have, you can completely handle. First of all, put the patient on the bed, try not to let the patient force and the action that can enhance the intra-abdominal pressure, so as to reduce the pressure in the esophageal vein to reduce bleeding, if the patient is restless or very nervous appropriate sedation is necessary. After doing the cardiac monitoring to understand the general situation of blood pressure, heart rate, oxygen saturation, urine volume, emergency blood tests, etc., you should also take comprehensive measures such as internal medicine to stop bleeding, acid control, drugs to reduce the pressure in the esophageal varices, etc., and combine with the patient’s complaints to estimate the amount of bleeding to determine how you rehydrate and how much fluid to rehydrate. Whether to perform fluid resuscitation, the end point of resuscitation, the type of resuscitation fluid, etc. These are immediately established in your mind. If the patient has hemorrhagic shock, I take the first critical step of not immediately transfusing blood, but actively controlling the bleeding. For hemorrhagic shock, aggressive fluid resuscitation does not improve the prognosis, but on the contrary, it will increase blood pressure and make the formed thrombus destroyed, causing further bleeding, and a large number of crystalloid infusions reduce blood viscosity and increase blood flow will also increase bleeding. It can even be lower, it can basically maintain the critical perfusion pressure of important organs, and massive fluid resuscitation can only reduce the survival rate. When the mean arterial pressure is not sufficient to maintain the visceral perfusion pressure, especially in the case of prolonged hypoperfusion, it may lead to multiple organ failure. At this time, the bleeding is basically controlled and appropriate fluid resuscitation can be given, and the mean arterial pressure should not be too high around 60 mmhg. At the same time, we observe the heart rate, blood pressure, urine output, and if possible, the patient’s cardiac output, oxygen consumption, oxygen delivery, acid-base balance, and blood lactate value. Of course, if the patient’s blood pressure rises too much, diuretics can be used to increase urine output and protect the kidneys at the same time. I follow the viewpoint of “volume first, blood transfusion second” in choosing the type of fluid. Some studies show that the increase of cardiac output by fluid input is inversely proportional to the density of cells in the fluid, and cell-free fluids such as colloids can increase cardiac output more effectively, while concentrated red blood cells have the worst effect. Therefore, late transfusion and late transfusion should be preferable. For life-threatening hemorrhage, it is also beneficial to choose a large amount of crystalloid to expand the volume, depending on the situation at the time to choose crystalloid or colloid. In my practical work I always adopt the strategy of delayed transfusion. For severe bleeding, we should grasp the purpose of transfusion and not blindly transfuse blood. Severe bleeding transfusion is to restore its oxygen-carrying function, while hypovolemia we are to restore the lost blood volume, not oxygen-carrying function, and supplemental fluids are sufficient. So there is no need to not transfuse blood. Also I would be aware that due to saline and sodium lactate Ringer’s solution may lead to hyperchloremia and acidosis. A large amount of crystalloid fluid can be plasma colloid osmotic pressure drop prone to tissue and pulmonary edema, and a small amount of ground colloid fluid can quickly restore CO and oxygen supply and improve microcirculatory perfusion. Therefore, in hemorrhagic shock we give crystalloids first to replace lost extracellular fluid is appropriate, and use colloid fluid in subsequent rehydration to reduce edema of vital organs. After such meticulous treatment, the patient can basically stop the bleeding and maintain stable vital signs, but the next most common problem may be the large amount of ascites due to the preliminary rehydration, as long as attention is paid to timely diuretic treatment during the resuscitation process, the patient will soon recover and be discharged. Patients and families will be satisfied with our treatment techniques, and most importantly, I can successfully save another patient’s life.