Traumatic Shock. X. the Treatment of Hemorrhagic Shock Irreversible to Replacement of Blood Volume Deficiency.

Since loss of blood volume is the initiating factor common to most types of traumatic shock, the therapeutic problem has been studied experimentally primarily from this point of view. Confusing or complicating factors, such as local trauma and the sepsis of trauma and anesthetics including barbiturates, have been eliminated by limiting the experimental method to simple hemorrhage in the unanesthetized animal, with or without morphine. Shock, so induced and maintained, exhibits all the classical phenomena expected and is responsive within certain variable limits of time and levels of blood pressure, to the restoration of all the shed blood. If the shock state is treated effectively first by a replacement of the blood volume deficiency, the shock is said to be "reversible" and as such does not represent a problem of challenging import. The problem, for our purpose, begins when and if the replacement of all shed blood, by whole blood or a blood substitute, fails to produce a sustained improvement equivalent to virtual recovery. This communication is concerned with the therapeutic value of a variety of agents administered after the shock has been showm to be irreversible tor the infusion of all shed blood. This we regard as the most valid technique for testing the efficacy of any agent.2