Shock and Its Treatment

THOUGH shock is due to many different causes, the clinical appearances are more or less constant; they vary only in degree, and are easily recognized in the more severe cases. The symptoms are increased pulse-rate, low blood-pressure, pallor, subnormal temperature, sweating, vomiting, thirst, and dry tongue; the mind is usually quite clear. In addition to the pallor, the skin of the ears and lips may show slight cyanosis. The signs are due to profound changes in the nervous, circulatory, and respiratory systems, and in the temperature-regulating mechanism. The amount of the fall in the blood-pressure and the reduction in volume of the circulating blood vary directly with the clinical condition, and indeed give a good quantitative estimate of the degree of shock present. As a result of study, in the last Great War, of the total blood volume and of the relative volume of red cells and plasma, using the vital red method and the haematocrit respectively, Keithl has divided shock into three stages according to its severity. Group 1.-Mild shock, in which the condition is good. There is a history of a not too severe injury or of a moderate primary hwamorrhage. On examination, there is some pallor, the pulse is 90-110, the systemic blood-pressure is over 95 mm., and the blood-volume is never below 75 per cent. These may be called compensated cases. Group 2.-The general condition is serious. The extremities are cold and clammy. The pulse is 120-140, the blood-pressure is 70-80 mm., the blood-volume is 65-75 per cent., and the volume of the red cells is increased relatively to that of the plasma. These cases are partially compensated. Grotup 3.-These cases are dangerously ill. The pulse is almost impalpable, the blood-pressure is below 60 mm., the blood-volume is less than 65 per cent., and on auscultation, the heartbeat is 120-160 per minute. They are not compensated. It is important to recognize to which group the patient belongs and to treat accordingly. The divisions suggested by these groups are not hard and fast. Intermediate stages occur, and an individual may and often does pass through two or even all three stages in a short time. Prior to the Great War of 1914-1918, the changes occurring in shock were not fully understood, but observations made then, and much painstaking work by experimental workers carried out since under controlled conditions, have shown many of the factors involved, and have …