Emergency War Surgery NATO Handbook: Part II: Response of the
Body to Wounding: Chapter IX: Shock and Resuscitation
Introduction
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
One encounters multiple classifications of the shock syndromes.
The common denominator in all forms of shock is inadequate capillary
perfusion. This chapter concerns itself with the diagnosis and
treatment of hemorrhagic shock, that clinical state in which the
capillary perfusion is inadequate to satisfy tissue requirements as a
result of the loss of blood. For the sake of completeness, we will
briefly mention the other forms of shock:
- Septic Shock -This syndrome results from the absorption of
bacterial toxins or toxic products from infected muscle or other
tissues in which debridement has not been performed or was
performed inadequately. Massive infection of serous cavities
especially predisposes to this potentially catastrophic
complication.
- Neurogenic Shock - Neurogenic shock results from autonomic
nervous system stimulation, causing either widespread
vasodilatation or the inhibition of vasoconstriction. This can
result in vascular collapse. Neurogenic shock may occur after head
injury, may be brought on by pain, or may occur on an emotional
basis. The pulse is slow, usually around 60/minute. The syndrome
is most often encountered in the operating room in association
with the rise of certain pharmacologic agents.
- Oligemic Shock - Oligemic shock, like hemorrhagic shock,
results from loss of circulation volume. The volume loss in this
situation usually results from severe, unreplaced, nonhemic
losses, such as those arising from severe vomiting or diarrhea.
ileus, intestinal obstruction, or enteric fistulas. Loss of plasma
by seepage, as occurs with but us, intestinal infarction, and
crush injury also results in external or extravascular "third
spaces" losses.
The combat surgeon should bear in mind that the most common cause
of death on the battlefield and during evacuation to the hospital is
exsanguination. Hemorrhagic shock is far and away the most commonly
encountered shock syndrome. Experience has also shown that the
majority of casualties, presenting in advanced shock will require
Surgical intervention to achieve hemostasis before stabilization and
hemodynamic improvement can be achieved and maintained.
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