A 58-year-old man with known alcoholic cirrhosis presents to the emergency department with massive hematemesis and progressive abdominal distension. On examination, he is hypotensive (BP 85/60 mmHg), tachycardic (HR 110 bpm), and has tense ascites. Endoscopy reveals actively bleeding esophageal varices. Which of the following is the most appropriate initial management step?

A. Administer intravenous propranolol and schedule elective band ligation: Propranolol is used for preventing future bleeding from varices, not for acute management. Band ligation is performed after stabilization, not in an emergency setting. B. Transfuse packed red blood cells to a hemoglobin >13 g/dL: Transfusions may be necessary for shock, but the goal is stabilization, not to achieve a specific hemoglobin level immediately. Blood transfusion should be done cautiously to correct hypovolemia. C. Initiate IV octreotide and antibiotics, and arrange for endoscopic variceal ligation: Octreotide helps control bleeding by reducing portal pressure, and antibiotics prevent infections. Endoscopic ligation is the definitive treatment for bleeding varices, after initial stabilization. D. Start diuretics to reduce ascitic fluid immediately: Diuretics are for chronic management of ascites, not acute bleeding. The priority is to control the hemorrhage and stabilize the patient first.