案例：患者，男性，40岁。既往体健。今晨突然呕鲜血300ml伴血块，继之排柏油样便2次，血压140/90mmHg，心率110次/分，肝肋下未触及，脾肋下2cm，腹部移动性浊音阳性。若患者入院时血压60/40mmHg，心率130次/分，则抢救时首先应采取的措施是

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