DOCSLIB.ORG

The Effect of Total Sympathectomy on the Occurrence of Shock from Hemorrhage

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Effect of Total Sympathectomy on the Occurrence of Shock from Hemorrhage THE EFFECT OF TOTAL SYMPATHECTOMY ON THE OCCURRENCE OF SHOCK FROM HEMORRHAGE N. E. Freeman, … , H. E. Holling, N. E. Marean J Clin Invest. 1938;17(3):359-368. https://doi.org/10.1172/JCI100960. Research Article Find the latest version: https://jci.me/100960/pdf THE EFFECT OF TOTAL SYMPATHECTOMY ON THE OCCURRENCE OF SHOCK FROM HEMORRHAGE By N. E. FREEMAN, S. A. SHAFFER, A. E. SCHECTER AND H. E. HOLLINGi WITH THE TECHNICAL ASSISTANCE OF N. E. MAREAN (From the Harrison Department of Surgical Research, School of Medicine, University of Pennsylvania, Philadelphia) (Received for publication January 20, 1938) Shock has been differentiated from hemor- shock in the experimental animal. This apparent rhage on the basis of hemoconcentration, nega- paradox was attributed to a reduction in the tive reaction to blood transfusions, and pathologi- volume flow of blood to the peripheral tissues cal changes in the tissues (1). In hemorrhage, produced by constriction of the arterioles. The dilution of the blood occurs while concentration hypothesis was advanced that vasoconstriction takes place in shock. After simple loss of blood, enabled the organism to adjust to the immediate prompt recovery follows transfusion, whereas in crisis. If this reaction were so intense and pro- severe shock, the administration of blood is fre- tracted, however, as to reduce the nutrient flow quently unavailing. It has been held that the to the tissues, shock would be produced. tissues are anemic after hemorrhage while the The reaction of normal dogs to hemorrhage pathological picture of shock is that of " dilatation was, therefore, compared with that of completely and engorgement of capillaries and vessels " (2). sympathectomized dogs. Particular attention was Blalock, however, in a convincing series of ex- paid to the function of vasoconstriction in main- periments (3), showed that the classical picture taining blood pressure, and at the same time in of shock with hemoconcentration, negative reac- restricting the flow of blood to the peripheral tis- tion to transfusion, and pathological changes in sues. Arterial blood pressure was correlated with the tissues, could be produced by hemorrhage the volume flow of blood through the paw. alone. In his experiments on dogs under local Death or recovery of the dog was used as the anesthesia, the blood pressure was maintained at ultimate criterion of shock. Concentration of a low level for several hours by means of hemor- rhage. At the end of this time, in spite of the the peripheral blood, alterations in the oxygen fact that all the blood which had been removed and carbon dioxide contents of the arterial and was reinjected, the blood pressure continued to venous blood, and the reactions of the dogs to fall and the animal died. The present experi- transfusions were noted. At the end of the ex- ments were performed to investigate further the periments various tissues were examined histo- mechanism through which shock was produced by logically. hemorrhage. It is recognized that vasoconstriction takes place METHODS after hemorrhage and this reaction has been de- Dogs were used which weighed between 11 and 22 scribed as protective (4). By means of con- kilograms. Under aseptic precautions, cannulae were traction of the vessels in the presence of hemor- inserted into the carotid artery and the jugular vein, or the femoral artery and vein. Pain was prevented by the rhage, the blood pressure is maintained at a level use of novocain in the operative wounds. The blood compatible with life. After removal of the vaso- pressure was determined by means of a Hurtle manom- constrictors by complete sympathectomy, cats eter, calibrated with a mercury manometer. Blood was under anesthesia are unable to tolerate as great obtained for analysis of the oxygen content and capacity a loss of blood as normal animals (5). In a and carbon dioxide content from the carotid artery and former communication (6), it was shown, on the from the right heart. The blood was taken under oil, other hand, that intense and prolonged vasocon- chilled, and analyzed at the conclusion of the experi- striction caused a reduction in blood volume and ment. The oxygen content and capacity, and the carbon dioxide content were determined by the method of Van 1 Travelling Fellow of the British Medical Research Slyke and Neill (7). In certain of the experiments the Council. plasma volume was determined by the method of Greger- 359 360 N. E. FREEMAN, S. A. SHAFFER, A. E. SCHECTER AND H. E. HOLLING TABLE I Data compiled from all the experiments on hemorrhage in the normal and sympathectomized dogs Hemoglobin Average after hemorrhage* After transfusion Per Time Dog Plasma Initial cent of Total Amount num- Weight vol- bleed- of initial hemor- trans- Mai- Concen- Result ber ume ing body bleed- rhage fused mum tration Blood Blood Dura- Blood Blood weigt i g .tata dliiu- after presure flow tion presure flow tion dilution cc. PCr cc. per 100 cc. 100 cc. kilos cc. cc. hours cc. cc. per cent per cent per cent mm. Hg paw so- hours mm. Hg paso o- umie per use per mninute minute NORMAL DOGW-DIND 25 14.2 766 5.4 3.6 766 830 106 94 117 67 0.9 6.6 60 0 Died 16 18.8 1010 814 4.3 1.4 889 845 78 64 83 70 1.5 2.1 50 1.0 Died 751 13.6 742 1000 7.3 1.9 1153 820 115 68 95 60 0.4 4.6 85 0.8 Died during rein- jection 767 17.4 800 907 5.2 1.9 1032 173 110 80 62 0.9 2.4 50 Acute cardiac failure 570 14.7 718 553 3.8 2.8 708 680 100 88 92 49 0.1 3.6 40 0 Died 2 14.7 1098 7.5 1.4 1055 465 42 0.1 2.0 30 Died duing rein- jection 546 22.0 1000 4.5 1.4 1000 1030 38 1.6 3.5 42 2.5 Died NORMAL DOGS-UCOYBURD 546 22.0 980 4.5 1.8 1217 900 86 62 69 2.9 2.2 130 20.4 Recovered 641 11.6 800 686 5.9 1.5 860 845 103 61 63 2.1 6.0 96 12.2 Recovered-sacrificed BYMATH5CTOMIUD DOGS 385 14.7 870 512 3.5 1.5 644 436 75 56 65 52 1.2 3.9 120 9.6 Recovered-acrificed 418 14.0 950 488 3.5 1.0 684 560 82 65 55 1.9 5.6 120 16.2 Recovered-living 14 14.0 504 3.6 1.0 581 513 50 0.8 4.7 168 38.0 Recovered-living * The average blood pressure and blood flow, after hemorrhage was calculated with a planimeter. sen (8).2 Hemoglobin estimations were made by the Blood, which had been removed under aseptic pre- Sahli method on blood taken from the ear. The volume cautions from donor dogs, was also injected in two of flow of blood through the hind paw was determined by the experiments so that the total amount of blood which the plethysmographic method previously described (9). these animals received after hemorrhage was larger than The temperature of the water bath in which the paw the amount which was removed during the experiment. was immersed was kept between 36° and 390 C. Complete sympathectomy was performed by removal The dogs were bled from the carotid or femoral ar- of the paravertebral sympathetic ganglia in three stages teries into a sterile container which contained 2.5 per as described by Cannon (10). The sympathectomized cent sodium citrate solution. The final dilution of ci- dogs had fully recovered from the effects of the opera- trate in blood was 0.25 per cent. tive procedures at the time they were used in the ex- After control observations on blood pressure and blood periments. flow were made, the dogs were bled at frequent intervals until the blood pressure and blood flow were reduced to RESULTS low levels from which rapid recovery did not occur. This period of hemorrhage is considered in Table I to In the normal dog, after the blood pressure be the time of initial bleeding. It varied from 1.4 to and blood flow had been reduced for a period 3.6 hours in the normal dogs and 1.0 to 1.5 hours in of hours by hemorrhage, shock was produced. the sympathectomized dogs. After this period of initial This condition was characterized by concentra- bleeding, the dogs were allowed to continue with a low tion of the peripheral blood, negative reaction to blood pressure and diminished blood flow as long as possible. If the blood pressure or blood flow started to blood transfusion, and failure to recover. Figure rise, blood was again withdrawn. When the blood 1 illustrates this reaction. In spite of the fact pressure started to decline spontaneously or if the dog that the blood pressure at no time fell below 60 showed signs of loss of consciousness, small amounts of mm. Hg the blood flow was reduced to a low blood were reinjected. level. At the end of three and one-half hours, 2 The blue dye T-1824 was obtained through the kind- the blood pressure failed to rise and the blood flow ness of Doctor Gregersen. started to fall spontaneously. Blood was then PREVENTION OF SHOCK BY SYMPATHECTOMY 361 FIG. 1. EFFECT OF HEMORRHAGE, FOLLOWED BY TRANSFUSION, ON THE VOLUME FLOW oF BLOOD THROUGH THE HIND PAW, THE BLOOD PRESSURE, AND THE HEMOGLOBIN CONTENT OF THE VENOUS BLOOD IN A NORMAL DOG.
Load more

Recommended publications
  • Derived Resuscitation Fluids on Euvolemic and Hypovolemic Rats
    PHYSIOLOGIC CHANGES INDUCED BY INTRAVENOUS INFUSION OF KERATIN- DERIVED RESUSCITATION FLUIDS ON EUVOLEMIC AND HYPOVOLEMIC RATS By FIESKY A. NUÑEZ JR, MD A Dissertation Submitted to the Graduate Faculty of WAKE FOREST UNIVERSITY GRADUATE SCHOOL OF ARTS AND SCIENCES In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY Physiology and Pharmacology May 2012 Winston-Salem, North Carolina ApProved by Thomas L. Smith, PhD, Advisor Mark Van Dyke, PhD, Chair George Christ, PhD Patricia Gallagher, PhD Ann Tallant, PhD DEDICATION To my wife: Alejandra, your infinite patience and understanding allowed me to mature as a Person and as a scientist. Without you I would not have accomplished this feat. I love you To my Parents, for your unconditional support that allowed this road to be filled with joy and success. To my sister: Mary, your wisdom and emotional suPPort gave me the strength and hope I needed in order to achieve many things. You always make me think of a better tomorrow and a better me. ii ACKNOWLEDGEMENTS Special Thanks to: Tom: For your impeccable mentorshiP and disPosition to always put my best interests first. Mark: For your dedication and Patience to teach such an impatient subject. Mike: For your knowledge and hard work in day-to-day lab efforts. Maria: Thank you for your patience in the lab and for sharing your immense knowledge of keratin with me. Keratin Krew and Biomaterials core: Roche, Bailey, Chris, Lauren, Mary, Julie, Jill, Carmen, DeePika. Your collaborations allow individual contributions to flourish into an extraordinary lab. OrthoaPedic Lab: Beth, Eileen, Martha, Jan, Casey.
    [Show full text]
  • THE CARDIO-CIRCULATORY EFFECTS in MAN of NEO- SYNEPHRIN (1-Α-Hydroxy-Β-Methylamino-3-Hydroxy- Ethylbenzene Hydrochloride)
    THE CARDIO-CIRCULATORY EFFECTS IN MAN OF NEO- SYNEPHRIN (1-α-hydroxy-β-methylamino-3-hydroxy- ethylbenzene hydrochloride) Ancel Keys, Antonio Violante J Clin Invest. 1942;21(1):1-12. https://doi.org/10.1172/JCI101270. Research Article Find the latest version: https://jci.me/101270/pdf THE CARDIO-CIRCULATORY EFFECTS IN MAN OF NEO-SYNEPHRIN (1-a-hydroxy-,8-methylamino-3-hydroxy-ethylbenzene hydrochloride) 1 BY ANCEL KEYS AND ANTONIO VIOLANTE (From the Laboratory of Physiological Hygiene, Medical School, University of Minnesota, Minneapolis) (Received for publication June 20, 1941) Neo-synephrin 2 differs chemically from epi- at least one day was allowed to elapse between studies nephrine only in the absence of the hydroxy group on any one subject. The general procedure in all studies was the same. para on the benzene ring. The in the position The subject rested quietly for 10 to 30 minutes and then first pharmacological studies with this substance measurements and observations were begun and continued emphasized the conclusion that the pharmacologi- for 10 minutes or more before the drug was adminis- cal action of neo-synephrin resembles that of epi- tered. Observations were continued for 1 to 4 hours nephrine in all respects, but the potency is less and following the administration. In all cases blood pressure the duration of effects is longer (12, 13, 21). and pulse rate were measured at frequent intervals throughout the entire experimental period. The same Inspection of the data in these papers shows, how- observer measured blood pressures throughout any one ever, that the pressor effect is relatively much experiment.
    [Show full text]
  • A New Treatment for Abdominal Surgical Shock
    Where it is possible the mucous membrane of and the skin is closed, except for a point at the the roof of the canal should not be destroyed and lower angle through which the catheter is brought the ends of the urethra will thus be prevented out. When the closure of the wound is complete, from retracting excessively. In the worst cases, ¿he patient is placed in a horizontal position, the where the urethra has been practically destroyed, catheter is adjusted at the proper point and is transverse division may be necessary. In many then fastened in position by a suture in the skin. of the inflammatory strictures, however, it is After-treatment. The important points in the possible to leave this strip on the roof which does after-treatment are— the care of the anterior not in any way interfere with the free mobilization urethra and the retention of the catheter until the of the anterior segment. For convenience of wound is completely healed. The care of the description, the steps of the operation will be anterior urethra has been described above, and given in order. the essential thing is that the urethra should be (1) With the patient in the lithotomy position a kept entirely clean with some solution which will free median incision is made down to the urethra, not produce undue irritation, and by some method dividing the structures of the bulb in the median which will not traumatize the suture. It has line and turning them aside. It is important that seemed to us that injection with a small syringe is this incision should be carried well backward so preferable to irrigation, either with a catheter or that the membranous urethra can be exposed.
    [Show full text]
  • Coronary Thrombosis
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1938 Coronary thrombosis R. W. Karrer University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Karrer, R. W., "Coronary thrombosis" (1938). MD Theses. 669. https://digitalcommons.unmc.edu/mdtheses/669 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. CORONARY THROMBOSIS by R. w. Karrer Senior Thesis presented to the College of Medicine, University of Nebraska Omaha, 1938. 480947 INTRODUCTION The terms coronary thrombosis, coronary occlusion, and cardiac or myocardial infarction are often em- ployed as synonyms, although there are useful differences in their meanings. In this thesis the author will deal only with that special type of coronary occlusion in which coronary thrombosis is the final event in the process of occlusion. Also, the thesis will be limited, more or less, to that type of thrombosis which is acute thrombosis of a coronary artery, rather than to the chronic type which is neither as spec­ tacular a disease nor as clean cut in its clinical picture. The definition of coronary thrombosis as given by Dorland {1935} is, "The formation of a clot in a branch of the coronary arteries which supply blood to the heart muscle, resulting in obstruction of the artery and infarction of the area of the heart supplied by the occluded vessel." Cecil (1935) modifies the definition in that he mentions the obstruction is generally acute.
    [Show full text]
  • The Action of Epinephrin Upon the Muscle Tissue of the Vein
    Proceedings of the Iowa Academy of Science Volume 18 Annual Issue Article 27 1911 The Action of Epinephrin upon the Muscle Tissue of the Vein J. T. M'Clintock Copyright ©1911 Iowa Academy of Science, Inc. Follow this and additional works at: https://scholarworks.uni.edu/pias Recommended Citation M'Clintock, J. T. (1911) "The Action of Epinephrin upon the Muscle Tissue of the Vein," Proceedings of the Iowa Academy of Science, 18(1), 125-129. Available at: https://scholarworks.uni.edu/pias/vol18/iss1/27 This Research is brought to you for free and open access by the Iowa Academy of Science at UNI ScholarWorks. It has been accepted for inclusion in Proceedings of the Iowa Academy of Science by an authorized editor of UNI ScholarWorks. For more information, please contact [email protected]. M'Clintock: The Action of Epinephrin upon the Muscle Tissue of the Vein THE ACTION OF EPINEPHBIN UPON THE MUSCLE TISSUE OP THE VEIN. The physiology of the venous circulation has, in comparison to that of the arterial, received very little consideration. It has been looked upon as a circulation carried on in a system of inert, elastic tubes, carrying the blood back to the heart from the periphery and without much, if any, physiological action on the part of the venous wall in the process. We are in the habit of looking to the heart, the arterial tension and the skeletal muscle action as being the forces driving the blood through the venous system. The venous part of the circulation is of equal importance to the arterial, for under the conditions as they exist the one cannot be with out the other and it is hardly to be expected that in so important a process the tissue would be left with only the physical force of elas ticity upon which to depend for meeting the variable conditions to which it must be subjected.
    [Show full text]
  • Controlled Hypotension 443 Some Other Than That at the Neuro-Muscular GRIFFITH, H
    Postgrad Med J: first published as 10.1136/pgmj.31.359.443 on 1 September 1955. Downloaded from September 1955 SCURR: Control of the Blood Pressure and Controlled Hypotension 443 some other than that at the neuro-muscular GRIFFITH, H. R., and JOHNSON, G. E. (1942), Anaesthesiology action, 3, 4I8. junction, which is as yet unknown. BENNETT, A. E. (1940), J.A.M.A., 144, 322. GRAY, R. W., et al. (I941), Psych. Quart., 15, 159. BIBLIOGRAPHY WATERTON. C. (x812), 'Wanderings in S. America,' Everyman BERNARD, CLAUDE (1843), ' Note sur la Curarine et ses effects Series, Dent, London. physiologiques,' Paris. BEECHER, H. K., and TODD, D. P. (I954), Ann. Surg., I, 140. >CONTROL OF THE BLOOD PRESSURE AND CONTROLLED HYPOTENSION By C. F. SCURR, M.V.O., M.B., B.S., D.A., R.C.S., F.F.A. Consultant Anaesthetist, Westminster Hospital; Honorary Anaesthetist, Hospital of Ss. John and Elizabeth Control of the Blood Pressure during the vagus and sympathetic, it can be improved by Anaesthesia humoral agents (adrenaline) and inotropic drugs, Blood pressure is the lateral pressure exerted by and is readily depressed by certain anaesthetic the blood on the vessel walls; our considerations agents which produce dilatation. Protected by copyright. are especially directed to the arterial system. The (b) Cardiac Filling: This depends on the length difference between systolic and diastolic pressure of diastole and the effective venous pressure. is the pulse pressure which depends on the stroke Venous pressure: The venous system accounts volume of the heart and the volume, elasticity and for 70 per cent.
    [Show full text]
  • Vascular Responses to Acute Intracranial Hypertension
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.34.5.587 on 1 October 1971. Downloaded from J. Neurol. Neurosurg. Psychiat., 1971, 34, 587-601 Vascular responses to acute intracranial hypertension S. S. HAYREH1 AND J. EDWARDS From the Department of Experimental Ophthalmology, Institute of Ophthalmology, University of London SUMMARY In 27 rhesus monkeys the cerebrospinal fluid pressure (CSFP) was raised by injections into the cisterna magna to about 40 to 50 mm Hg in steps of 5 mm Hg every five minutes. During the initial phase of the rise of the CSFP to about 15 mm Hg normal animals showed a significant fall in the systolic arterial blood pressure. With a further elevation of the CSFP the BP rose till the CSFP reached 30 to 40 mm Hg. If the CSFP were raised higher than that, a large number of the animals showed a significant fall in the BP. In animals which were shocked before the CSFP was raised there was no drop in the systolic BP during the initial phase. This study indicates that vascular decompensation occurs in the majority of animals when the CSFP goes higher than 30 to 40 mm guest. Protected by copyright. Hg; there is a significant rise in the pulse rate, superior sagittal sinus pressure (SSP), and internal jugular vein pressure (JVP). The JVP was related to the SSP, indicating that the JVP most probably reflected the pressure changes in the intracranial venous sinuses. Four animals suddenly collapsed at the highest CSFP. In the remaining 23 animals, on a sudden lowering of the CSFP to zero from the highest level, 13 monkeys died in less than half an hour and four in about an hour, while six animals stood this elevation of the CSFP well, with a good recovery.
    [Show full text]
  • Resuscitation-Fluid Replacement W
    Postgrad Med J: first published as 10.1136/pgmj.43.503.592 on 1 September 1967. Downloaded from Postgrad. med. J. (September 1967) 43, 592-598. Resuscitation-fluid replacement W. G. PROUT R. VAUGHAN JONES M.B., F.R.C.S. M.B., M.R.C.P., M.C.Path. Surgical Registrar, Consultant Pathologist, St Peter's Hospital, Chertsey, and St Thomas' Hospital, London North West Surrey Group Laboratory St Peter's Hospital, Chertsey THIS short account will be confined to the dromes with no common single clinical manifesta- management of circulatory failure in the first few tion. hours after reception of the patient in a Casualty Bloch et al. (1966) define shock as a state of Department. Where shock is due to trauma the progressive circulatory failure in which the cardiac cause will usually be obvious, but many shocked output is insufficient to meet tissue requirements cases brought to Casualty Departments suffer for nutrition, oxygenation or waste disposal. This from other diseases in which circulatory failure definition serves to emphasize the basic patho- may be complex in origin. For this reason we have logical feature, that of defective tissue perfusion. also discussed non-traumatic causes. For the different forms of shock, further terms have been introduced. Shires (1967) has suggested Traumatic shock subdivision into haematogenic, neurogenic, vaso- It is generally agreed that reduction in the genic and cardiogenic forms, but these are termsby copyright. circulating blood volume is the main factor in the without therapeutic implication. McGowan & production of traumatic shock. When external or Walters (1966) point out that clinically two internal haemorrhage takes place, the fluid lost is, patterns of circulatory upset are most often seen of course, blood.
    [Show full text]
  • Cardiogenic Shock
    Res Medica, Spring 1969, Volume VI, Number 3 Page 1 of 8 Cardiogenic Shock Andrew G. Leitch B.Sc. Abstract DEFINITION AND PATHOGENESIS INCIDENCE Cardiogenic shock is shock occurring after myocardial infarction. It has been variously described as occurring in 6%, 8%, 10%, 12% and 20% of patients with myocardial infarction. Shock accompanies the onset of pain in few eases and most cases occur in the first twenty-four hours after infarction although they may occur several days after. CLINICAL CRITERIA The criteria for diagnosis of shock may vary with different authors (hence the anomalous 20% above) but, in general, it is agreed that shock is suggested clinically by the following features: cold, clammy extremities, pallor and cyanosis, rapid, thready pulse, anuria or oliguria, anxiety, restlessness or apathy, and prolonged hypotension. The only objective assessment is of blood pressure and this alone does not define shock. Considerable variation may therefore be expected in diagnosis. In view of the difficulties in defining the criteria for diagnosis of shock, the individual criteria and the interpretations placed upon them warrant further discussion. Copyright Royal Medical Society. All rights reserved. The copyright is retained by the author and the Royal Medical Society, except where explicitly otherwise stated. Scans have been produced by the Digital Imaging Unit at Edinburgh University Library. Res Medica is supported by the University of Edinburgh’s Journal Hosting Service: http://journals.ed.ac.uk ISSN: 2051-7580 (Online) ISSN: 0482-3206 (Print) Res Medica is published by the Royal Medical Society, 5/5 Bristo Square, Edinburgh, EH8 9AL Res Medica, Spring 1969, 6(3): 13-19 doi: 10.2218/resmedica.v6i3.851 Leitch, A.
    [Show full text]
  • Study on Alterations of Blood Flow and Blood Viscosity Under Hemorrhagic Shock and Effects of Plasma Expander
    Nagoya J. me d. Sci. 31: 339-355. 1969. STUDY ON ALTERATIONS OF BLOOD FLOW AND BLOOD VISCOSITY UNDER HEMORRHAGIC SHOCK AND EFFECTS OF PLASMA EXPANDER YosHIKAzu MATSUNAGA 1st Department of Surgery, Nagoya Univeys?fy School of Medicine (Director: Prof. Yoshio Hashimoto) ABSTRACT Experiments were performed in 48 dogs subjected to a shock produced by hemorrhage after the modified Wiggers' method. Dogs were infused 90 minutes after hemorrhage with one of six test substances; shed blood, 5% glucose solution, or four kinds of dextran ( mw. 75,000, 47,000, 29,000 and 12,000 ). Infusion of dextran with mw. 29,000 produced the most remarkable increase in femoral arterial blood flow above the prehemorrhagic level. This flow improvement was thought to be more attributable to reduction in blood viscosity than an increase in blood volume. INTRODUCTION The development of shock is a complicated phenomenon not necessarily causally related to any one factor. The shock may be resulted from a multi­ plicity of influences such as hormonal, neural, circulatory and so onn. Hemorrhage, if it is significant in amount, may cause irreversible responses of the circulatory system. Maintenance of blood volume and blood pressure is necessary, but there is no guarantee to restore capillary circulation even with an adequate blood replacement. The circulatory conditions after hemorrhage are accompanied by cellular aggregation or sludging, increased blood viscosity and venular stasis of cells11 - 41 • Cellular aggregation, if uncorrected, may reduce nutritive capillary blood flow and result in hypoxic damages of the parenchy­ matous organs. A failure of capillary circulation is related to a principal cause of a fatal process.
    [Show full text]
  • Irwin and Rippe's Intensive Care Medicine
    BOOKS,SOFTWARE,&OTHER MEDIA findings. This chapter emphasizes a step- therapy and explains the various classes of ment chart would have been extremely help- ␤ by-step approach to thorough physical ex- drugs, such as anti-infectives, 2 adrener- ful. amination and defining normal findings with gics, corticosteroids, and xanthines. In- The highlights in each of these chapters abnormal findings that the practitioner may cluded in this section are drug-delivery were the author’s inclusion of educational encounter. The chapter also includes “age methods (eg, metered-dose inhaler, powder discharge notes, which will help clinicians awareness” alerts to which the clinician inhaler), indications, adverse effects, and and student prepare the patient and family should pay close attention when assessing points to which the clinician should pay close for discharge by making them aware of pos- children or the elderly, and “red flags” to attention when delivering medications. Also sible outcomes. Overall, each of these chap- highlight subjects that could be of great im- included are discussions on inhalation ther- ters was what I would call the “CliffNotes” portance (eg, during chest inspection, watch apy, continuous positive airway pressure, for most common respiratory diseases and for areas of abnormal collapse during inspi- mechanical ventilation, and bronchial hy- problems. These supplement big heavy ration or abnormal expansion during expi- giene. I found all the treatments to be very pathophysiology books very well, and this ration, which could signify paradoxical accurate and according to the American As- book is an easy-to-use reference. movement). The “age awareness” and “red sociation for Respiratory Care clinical prac- The last chapter, on emergencies, mainly flag” alerts appear throughout the book and tice guidelines.
    [Show full text]
  • Historical Paper in Surgery a Brief History of Shock
    Historical Paper in Surgery A brief history of shock Frederick Heaton Millham, MD, Newton, MA From Newton Wellesley Hospital, Newton, MA RECENTLY,2MIDDLE-AGED COUSINS were admitted to context. My intention is to discuss the term as it is the Level I trauma center where I attend as a used in the surgical and trauma literature. In a trauma surgeon. Each had been shot twice. Their setting of hemodynamic instability, this word is wounds were similar; both suffered a single gun- frequently used to indicate a syndrome of hypoten- shot wound to the epigastrium and a second sion, tachycardia, and mental status change owing, wound in the left flank. The first cousin (let us presumably, to ‘‘inadequate tissue perfusion.’’ To- call him Joe), had a normal pulse and blood pres- day we use the word shock to describe patients in sure and was oriented and composed; his skin was extremis who suffer from a variety of distinct pink and dry. The second cousin (let us call him pathophysiologic processes, such as severe cardiac Frank) was hypotensive and tachycardic; he was ap- dysfunction or overwhelming infection that share athetic and disoriented, although paramedics re- insufficient tissue perfusion as a consequence. ported that he had been agitated and combative The story of how this word came to be attached in the field just minutes before. His skin was pale to these dramatic clinical syndromes and how our and he was diaphoretic. There was 1 operating predecessors conceptualized the physiology of room immediately available and 1 that would be shock is a central theme of the past 300 years of ready in 20 minutes.
    [Show full text]