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I.—Shock may be defined as “The clinical condition which follows an injury producing depressed vitality, associated with lowered blood-pressure, deficient circulating fluid, diminished intracellular oxygenation and reduced body temperature.” Such a condition results from the presence of one or more of the following four factors, acting either singly or in combination: (1) Pain, (2) hæmorrhage, (3) cold, (4) toxæmia, either of bacterial, tissue, or other origin.
II.—Secondary traumatic shock is the common type and only becomes established slowly.
III.—Prevention is successful in many cases, even under front line conditions and in war surgery.
IV.—Treatment of an established case: (1) Application of warmth and mental rest. (2) Relief of pain, (3) restoration of deficient circulation, giving fluids by mouth, rectally, or by 10 per cent. glucose saline solution intravenously (1 litre in two hours). (4) Increase of deficient intracellular oxygenation by insulin hypodermically (5 units at beginning and end of glucose injection). (5) If operation is needed, by choosing a local or gas and oxygen anæsthesia.