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Relentless Shock

Marcus Backer, M.D.; Michael A. Dean, M.D.; Emilio P. Iasiello, M.D.
JAMA. 1960;174(10):1282-1286. doi:10.1001/jama.1960.03030100050011.
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Hypotension lasting many days is illustrated by two case histories. In a 61-year-old man it followed coronary occlusion and myocardial infarction; in a 74-year-old man it appeared on the second day after abdominal surgery. In both cases constant treatment with metaraminol bitartrate or other vasopressor drugs became necessary, and interruptions of such treatment were regularly followed by relapses into the hypotensive state, with signs of vasomotor collapse. It was found possible to terminate vasopressor medication on the 55th day in the first patient and the 22nd day in the second. These cases suggest many questions as to the definition, mechanism, and treatment of shock, especially since there was no evidence of reduced cardiac output as the fundamental mechanism in the second case.


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