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Medical ArticlesPathologic Physiology
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Source: Disturbances Of The Heart
The treatment of shock will probably always be unsatisfactory as the
cause is so varied, and, although circulatory prostration and
vasomotor paresis always constitute the acute condition, the
physiologic health of the heart and blood vessels is so varied. The
patient in shock has low temperature, low blood pressure, and a
pulse either rapid or slow, but excessively feeble; the face is
pale, the surface of the body cold, and there is more or less clammy
perspiration; there may be dyspnea and cardiac anxiety, or the
patient may hardly breathe.
An acute cause, as terrible pain or hemorrhage, must of course be
stopped immediately. There is more or less anemia of the brain, and
therefore the legs and perhaps the lower part of the body should be
elevated. It may even be wise to drive the blood from the legs by
Esmarch bandages into the rest of the circulation. As there is
always more or less paresis and dilatation of the large veins of the
splanchnic system, a tight bandage about the abdomen is of great
advantage in raising the blood pressure to the safety mark.
Strophanthin, given intravenously, is valuable as a quick
restorative of the heart. Digitalis is so slow that it is of little
value in an emergency. Camphor hypodermically, and hot liquids
(nothing is better than black coffee) given by the mouth, are
valuable remedies. The camphor may be repeated frequently.
Strychnin, the long-used stimulant, should generally be given, but
in not too large doses and not too frequently repeated; 1/30 grain
hypodermically is generally a large enough dose; this dose may be
repeated in three or four hours, but should ordinarily not be given
oftener than once in six hours. An aseptic preparation of ergot
given intramuscularly is most efficient in raising the blood
pressure and aiding the heart. One dose of brandy or whisky may do
no harm. Alcohol, however, should not be pushed.
A most important procedure in all kinds of shock is to surround the
patient with dry heat, hot-water bags, and hot flannels; gentle
friction of the arms and legs, unless the patient is too exhausted,
may be of benefit. A hot-water bag to the heart is always a
stimulant. Sometimes friction over the base of the heart in the
region of the auricles is of benefit.
If the collapse is not acute and there is gradual profound
prostration, or if the patient is improved but still in a serious
condition of shock, too energetic measures must not be used; neither
should too many drugs be administered, or drugs in too large doses.
Absolute quiet and the administration of liquid nourishment in but
small amounts at a time are essential.
The hypodermic administration of epinephrin solutions, 1:10,000, or
solutions of pituitary extract, 1:10,000, should be considered; they
are often valuable.
If the shock occurs in ether or chloroform anesthesia, the
vasopressor stimulating effect of inhalations of carbon dioxid gas
may be considered, as advised by Henderson."
If the shock is due to hemorrhage and the hemorrhage has ceased, a
transfusion of physiologic saline solution is generally indicated.
Transfusion of blood under the same conditions is still better.
Rarely is transfusion indicated in shock from other causes; it often
adds to the difficulty rather than improves it. Occasionally if
shock is decided to be due to a toxemia, the toxin may be diluted by
the withdrawal of a small amount of blood and the transfusion of an
equal amount of saline solution.
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