There is little controversy regarding the dire clinical status of the patient who presents with prostration, hypotension, pallor, coldness, moisture of the skin, collapse of superficial veins, suppression of the formation of urine, and usually, obtunded mental status. The term "shock" is descriptive of these signs and above all, communicates the ominous prognosis. The physician is prompted to minimize any delays. His diagnostic assessment is brief and his singular commitment is to therapy.
The dilemma is great. At a time when the clinician is called upon to marshal the full resource of his professional judgment, he has least opportunity for careful diagnostic assessment. To the contrary, treatment may be directed primarily to a reversal of the signs of shock without reference to its underlying cause and without adequate undertanding of the mechanisms accounting for shock. Symptomatic treatment of shock often becomes the mainstay of medical management.
With the establishment of