Three things remain paramount in successful management of massive upper gastrointestinal hemorrhage. These are knowledge of the source, accurate estimation of the rate of blood loss, and adequate replacement. In addition, prompt surgical intervention will be required for some patients lest exsanguination occur. With whole blood readily available, and with close cooperation between physician and surgeon, as the current literature so often admonishes, convincing evidence of effective management should appear in a lowered mortality rate for all bleeding patients, whether operated upon or not. A survey of the past 10 years' experience has been made to evaluate the effectiveness of this approach.
During this period, management has included certain important steps. When a patient bleeding heavily from the upper gastrointestinal tract is encountered, 6 pt. (3000 cc.) of whole blood is crossmatched, and initial therapy for shock is given as needed. An estimate of initial blood loss is made, and