Treatment of Shock: Practical Aspects

¹ An Instructional Course Lecture of The American Academy of Orthopaedic Surgeons

Irreversible shock is a rare circumstance in young and otherwise healthy patients if prompt and adequate blood replacement is performed. This is not necessarily true of the civilian population where cardiac, renal, cerebral, general vascular, and metabolic factors may alter not only the shock, but also its responsiveness to treatment and even to the form which that therapy must take.

The basic treatment in traumatic shock is the replacement of blood, although plasma expanders of one type or another may suffice temporarily. The use of either blood or plasma expanders carries certain hazards which must be accepted as a compromise in treatment of shock. These hazards make it important not to administer blood or blood substitutes indiscriminately when a need does not exist. Steroids and vasoconstricting agents in general play a very limited role in shock therapy.

One of the vicious cycles in shock that may be encountered is the development of acidosis; in acidosis there is lessened response to physiologic vasoconstriction and lessened cardiac ventricular contractile force.

Nevertheless, the most likely cause of continued hypotension in the injured patient after a seemingly appropriate volume of blood has been given is still an unrecognized and uncontrolled site of hemorrhage. As a rule, this situation must be corrected by prompt surgical intervention.

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