Shock


Categories: Uncategorized
Sources: 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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