The gravity and complexity of problems encountered in the management of patients bleeding severely from the upper gastrointestinal tract have prompted numerous studies of the factors involved.1-7 Many diverse approaches toward the treatment of such patients have resulted. Since the criteria of "massive hemorrhage" and the indications for operative treatment have not been uniform, it is difficult to draw firm conclusions from these reports. A few common factors have emerged. The patient who bleeds acutely, and who may present with a normal hemoglobin and hematocrit in the face of a 30% or greater reduction in blood volume, requires earlier and more aggressive therapy than one who bleeds slowly enough to permit some compensatory hemodilution. The patient who has serious concomitant disease is in far greater jeopardy from hemorrhage than an otherwise healthy person who suffers loss of blood to the same extent. Early surgical intervention appears helpful, especially when
CUSHMAN WF, DeMAIO JT. Experience With Local Gastric Cooling. Arch Surg. 1964;89(4):719–724. doi:10.1001/archsurg.1964.01320040135024
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