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Intensive Study and Treatment of Shock in Man

Robert M. Hardaway, MC; Paul M. James Jr., MC; Robert W. Anderson, MC; Carl E. Bredenberg, MC; Robert L. West, MC
JAMA. 1967;199(11):779-790. doi:10.1001/jama.1967.03120110051007.
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The most important treatment of noncardiac shock is fluid volume administration given, if necessary, to the point of an elevated central venous or pulmonary artery pressure. Adequate volume is more important than the type of fluid administered. Blood is given only up to a normal red blood cell mass. If these measures are not adequate, a vasodilator may produce dramatic improvement. No detrimental effect was ever seen. Vasopressors may produce detrimental effects in shock. An adequate arterial oxygen pressure (Po2) is essential and often requires tracheotomy or tracheal intubation with oxygen and a respirator to obtain. It has been possible to correct all hemodynamic defects in shock. Patients who have died have done so as a result of pulmonary lesions. Disseminated intravascular coagulation is usual in severe shock. Its onset is heralded by a clotting defect frequently only noted by laboratory test. In some cases it causes important clinical hemorrhage and requires treatment. It may play an important part in the development of lethal shock including acute pulmonary failure.


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