Search tips
Search criteria 


Logo of procrsmedFormerly medchtJournal of the Royal Society of MedicineProceedings of the Royal Society of Medicine
Proc R Soc Med. 1977; 70(Suppl 2): 25–35.
PMCID: PMC1543336

Dopamine in the management of shock.


Shock is a syndrome with serious prognostic implications--the harbinger of death. Hypoperfusion of essential organs is common, though total blood flow may be significantly greater than normal. Specific therapy is directed to the specific inciting event--infection, abscess, tamponade, &c. Symptomatic therapy keeps the patient alive until we discover the specific problem or until he recovers spontaneously. The intravascular volume must be carefully monitored and corrected, using the pulmonary wedge pressure as the principal guide, and colloid osmotic pressure must be maintained. If the patient does not respond to volume augmentation alone then inotropic drugs may be needed, and of these dopamine is a selective vasodilator which redirects blood flow to the critical organs. The outstanding challenge in shock is the maldistribution of perfusion in the microvasculature. Although this may be ameliorated by the early administration of large doses of glucocorticoids, there is little convincing that these drugs constitute more than supportive therapy. Of greatest importance is reevaluation, reevaluation, and reevaluation. The patient in shock becomes a new patient every five minutes. Drugs that formerly worked, doses previously optimal--these are no guide because the situation changes so rapidly. The principles of management are to monitor vital functions, constantly vary drugs and doses, and continually attempt to put right all the parameters measured. This strategy will be more effective when we know what parameters to measure.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.9M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cady LD, Jr, Weil MH, Afifi AA, Michaels SF, Liu VY, Shubin H. Quantitation of severity of critical illness with special reference to blood lactate. Crit Care Med. 1973 Mar-Apr;1(2):75–80. [PubMed]
  • Cohn JD, Engler PE, Del Guercio LR. The automated physiologic profile. Crit Care Med. 1975 Mar-Apr;3(2):51–58. [PubMed]
  • Luz da PL, Shubin H, Weil MH, Jacobson E, Stein L. Pulmonary edema related to changes in colloid osmotic and pulmonary artery wedge pressure in patients after acute myocardial infarction. Circulation. 1975 Feb;51(2):350–357. [PubMed]
  • Gann DS, Pirkle JC., Jr Role of cortisol in the restitution of blood volume after hemorrhage. Am J Surg. 1975 Nov;130(5):565–569. [PubMed]
  • GUYTON AC, LINDSEY AW. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res. 1959 Jul;7(4):649–657. [PubMed]
  • Moss G, Stein AA. Cerebral etiology of the acute respiratory distress syndrome: diphenylhydantoin prophylaxis. J Trauma. 1975 Jan;15(1):39–41. [PubMed]
  • Moss G, Staunton C, Stein AA. The centrineurogenic etiology of the acute respiratory distress syndromes. Universal, species--independent phenomenon. Am J Surg. 1973 Jul;126(1):37–41. [PubMed]
  • Carlson RW, Schaeffer RC, Jr, Whigham H, Michaels S, Russell FE, Weil MH. Rattlesnake venom shock in the rat: development of a method. Am J Physiol. 1975 Dec;229(6):1668–1674. [PubMed]
  • RILEY RL, COURNAND A. Analysis of factors affecting partial pressures of oxygen and carbon dioxide in gas and blood of lungs; theory. J Appl Physiol. 1951 Aug;4(2):77–101. [PubMed]
  • An ethical consideration of large-scale clinical trials in cardiovascular diseases. Report of the Committee on Ethics of the American Heart Association. Circulation. 1975 Sep;52(3):5–9. [PubMed]
  • Shoemaker WC, Elwyn DH, Levin H, Rosen AL. Early prediction of death and survival in postoperative patients with circulatory shock by nonparametric analysis of cardiorespiratory variables. Crit Care Med. 1974 Nov-Dec;2(6):317–325. [PubMed]
  • Shoemaker WC, Launder WJ, Castagna J, State D. Method for estimation of the perfusion defect in shock. J Surg Res. 1976 Feb;20(2):77–84. [PubMed]
  • Shoemaker WC, Montgomery ES, Kaplan E, Elwyn DH. Physiologic patterns in surviving and nonsurviving shock patients. Use of sequential cardiorespiratory variables in defining criteria for therapeutic goals and early warning of death. Arch Surg. 1973 May;106(5):630–636. [PubMed]
  • Shubin H, Afifi AA, Rand WM, Weil MH. Objective index of haemodynamics status for quantitation of severity and prognosis of shock complicating myocardial infarction. Cardiovasc Res. 1968 Oct;2(4):329–337. [PubMed]
  • Shubin H, Weil MH, Afifi AA, Portigal L, Chang P. Selection of hemodynamic, respiratory and metabolic variables for evaluation of patients in shock. Crit Care Med. 1974 Nov-Dec;2(6):326–336. [PubMed]
  • Siegel JH, Greenspan M, Del Guercio LR. Abnormal vascular tone, defective oxygen transport and myocardial failure in human septic shock. Ann Surg. 1967 Apr;165(4):504–517. [PubMed]
  • Beck JC, Lee PR, LeRoy L, Stalcup J. The primary care problem. Clin Res. 1976 Oct;24(4):258–266. [PubMed]
  • Weil MH, Morissette M, Michaels S, Bisera J, Boycks E, Shubin H, Jacobson E. Routine plasma colloid osmotic pressure measurements. Crit Care Med. 1974 Sep-Oct;2(5):229–234. [PubMed]
  • Winkel P, Afifi AA, Cady LD, Jr, Weil MH, Shubin H. Application of statistical techniques for assessment of prognosis in patients with acute circulatory failure (shock). J Chronic Dis. 1971 Jun;24(1):61–69. [PubMed]

Articles from Proceedings of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press