The modern treatment of shock based on physiologic principles

The hemodynamic disturbances resulting from shock due to hemorrhage or endotoxins and the results of several methods of treatment are presented. The experimental data indicate that vasopressors intensify the visceral vasoconstriction, ischemia, and loss of capillary integrity characteristic of severe shock. The benefical effects of corticosteroids or phenoxybenzamine combined with volume replacement are indicated. The hemodynamics of shock appear to be similar in man and animals, although the visceral organ which suffers the greatest insult varies among the species. This concept of a basic hemodynamic mechanism of shock gains further support from the fact that the same therapy in dog and man produces similar results. In treating patients with actual or suspected bacterial shock, we prefer a regimen of hydrocortisone, plasma to replace volume loss, specific antibiotic therapy, and surgical intervention when necessary to eliminate the source of infection. Hydrocortisone is used in preference to phenoxybenzamine because it has a more subtle effect on vascular tone and is less likely to cause further hypotension. Plasma is preferred to low molecular dextran because of our concern over the combined effects of endotoxin shock and dextran on basic blood clotting mechanisms in man.