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November 13, 1943, Vol 123, No. 11 >
ARTICLE | November 13, 1943

THE CIRCULATION IN THE SKIN IN THE SHOCK SYNDROME: Title and subTitle BreakCOMPARISON OF SIMPLE PROGNOSTIC FEATURES OF CLINICAL VALUE FREE

JOSEPH R. DiPALMA, M.D.
[+] Author Affiliations

Mrs. Blanche V. Richard rendered valuable technical assistance.

This investigation has been aided by a grant from the Josiah Macy Jr. Foundation.

Dr. Walter B. Cannon and Dr. S. R. M. Reynolds read and criticized the manuscript of this paper, for which the author is grateful.


BROOKLYN

From the Department of Medicine, Long Island College of Medicine, Kings County Hospital Division.


JAMA. 1943;123(11):684-693. doi:10.1001/jama.1943.02840460018006
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References

"Early diagnosis and early adequate treatment" is a maxim which applies with particular emphasis to the shock syndrome. If impending shock could be suspected and treated effectively before changes in blood pressure and pulse sound the clarion call of approaching death, lives could be saved. Indeed it is even maintained by some observers that when the blood pressure falls and is maintained for an appreciable time below the so-called "critical level" and pulse changes are pronounced, a stage of shock has been attained which is frequently irreversible.1 Hence the need for simple clinical methods which provide a means of diagnosing impending shock at the earliest possible moment. To accomplish this many attempts have been made; to date not one remains so effective as a serial follow-up of blood pressure and pulse. Among the promising are studies of blood concentration. Unquestionably they are of value in the shock arising from

REFERENCES

1 +
Cannon, W. B., and Cattell, McK.:  Studies in Experimental Traumatic Shock: V. The Critical Level in a Falling Blood Pressure , Arch. Surg. 4:300 ( (March) ) 1922;.
2 +
Scull, C. W., and Eiman, J.:  Physiological and Clinical Basis for Treatment of Shock , Clinics 1: 43 ( (June) ) 1942;.
3 +
Scudder, J.: Shock: Blood Studies as a Guide to Therapy , Philadelphia, J. B. Lippincott Company, 1940;.
4 +
Weiss, Soma:  Syncope, Collapse and Shock , Proc. Inst Med. Chicago 13:2 ( (Jan.) ) 1940;.
5 +
DiPalma, Reynolds and Foster (footnotes 9 and 11).
6 +
Grant, R. T.:  Memorandum on the Observations Required in Cases of Wound Shock , Brit. M. J. 2:332 ( (Sept. 6) ) 1941;.
7 +
Wiggers, C. J.:  Present Status of the Shock Problem , Physiol. Rev. 22:74 ( (Jan.) ) 1942;.
8 +
Harkins, H. N.:  Recent Advances in the Study and Management of Traumatic Shock , Surgery 9:231 ( (Feb.) ), 447 (March), 607 (April) 1941;.
9 +
Patients in this study included those in both the open and closed divisions of medicine and surgery at Kings County Hospital. The many members of the staff, both doctors and nurses, gave unstinting cooperation.
10 +
Lewis, Thomas: The Blood Vessels of the Human Skin and Their Responses , London, Shaw & Sons, Ltd., 1927;.
11 +
DiPalma, J. R.; Reynolds, S. R. M., and Foster, F. I.:  Quantitative Measurement of Reactive Hyperemia in Human Skin , Am. Heart J. 23: 377 ( (March) ) 1942;.
12 +
DiPalma, J. R., and Foster, F. I.:  The Segmental and Aging Variations of Reactive Hyperemia in Human Skin , Am. Heart J. 24: 332 ( (Sept.) ) 1942;.
13 +
DiPalma, J. R.; Muss, I., and Foster, F. I.:  A Reactive Hyperemia Ring Test in the Study, Evaluation and Prognosis of Pedal Lesions Caused by Arteriosclerosis Obliterans and Arterial Embolism , Am. Heart J. 24:345 ( (Sept.) ) 1942;.
14 +
DiPalma, J. R.; Reynolds, S. R. M., and Foster, F. I.:  Measurement of the Sensitivity of the Smallest Blood Vessels in Human Skin: Responses to Graded Mechanical Stimulation in Normal Men , J. Clin. Investigation 20:333 ( (July) ) 1941;.
15 +
DiPalma, J. R.:  Quantitative Alterations in the Hyperemic Responses to Local Ischemia of the Smallest Blood Vessels of the Human Skin Following Systemic Anoxemia, Hypercapnia, Acidosis and Alkalosis , J. Exper. Med. 76:401 ( (Nov.) ) 1942;.
16 +
DiPalma, J. R., and Foster, F. I.:  Sensitivity of the Smallest Cutaneous Blood Vessels: Quantitative Responses to Graded Mechanical Stimulation and to Local Ischemia in Arterial Hypertension, Arteriosclerosis and Certain Allied Disorders , J. Clin. Investigation 21:675 ( (Nov.) ) 1942;.
17 +
Reynolds, S. R. M.; Hamilton, J. R.; DiPalma, J. R.; Hubert, G. B., and Foster, F. I.:  Dermovascular Change: Dermovascular Actions of Certain Steroid Hormones in Castrate, Eunuchoid and Normal Men , J. Clin. Endocrinol. 2:228 ( (April) ) 1942;.

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1 +
Cannon, W. B., and Cattell, McK.:  Studies in Experimental Traumatic Shock: V. The Critical Level in a Falling Blood Pressure , Arch. Surg. 4:300 ( (March) ) 1922;.
2 +
Scull, C. W., and Eiman, J.:  Physiological and Clinical Basis for Treatment of Shock , Clinics 1: 43 ( (June) ) 1942;.
3 +
Scudder, J.: Shock: Blood Studies as a Guide to Therapy , Philadelphia, J. B. Lippincott Company, 1940;.
4 +
Weiss, Soma:  Syncope, Collapse and Shock , Proc. Inst Med. Chicago 13:2 ( (Jan.) ) 1940;.
5 +
DiPalma, Reynolds and Foster (footnotes 9 and 11).
6 +
Grant, R. T.:  Memorandum on the Observations Required in Cases of Wound Shock , Brit. M. J. 2:332 ( (Sept. 6) ) 1941;.
7 +
Wiggers, C. J.:  Present Status of the Shock Problem , Physiol. Rev. 22:74 ( (Jan.) ) 1942;.
8 +
Harkins, H. N.:  Recent Advances in the Study and Management of Traumatic Shock , Surgery 9:231 ( (Feb.) ), 447 (March), 607 (April) 1941;.
9 +
Patients in this study included those in both the open and closed divisions of medicine and surgery at Kings County Hospital. The many members of the staff, both doctors and nurses, gave unstinting cooperation.
10 +
Lewis, Thomas: The Blood Vessels of the Human Skin and Their Responses , London, Shaw & Sons, Ltd., 1927;.
11 +
DiPalma, J. R.; Reynolds, S. R. M., and Foster, F. I.:  Quantitative Measurement of Reactive Hyperemia in Human Skin , Am. Heart J. 23: 377 ( (March) ) 1942;.
12 +
DiPalma, J. R., and Foster, F. I.:  The Segmental and Aging Variations of Reactive Hyperemia in Human Skin , Am. Heart J. 24: 332 ( (Sept.) ) 1942;.
13 +
DiPalma, J. R.; Muss, I., and Foster, F. I.:  A Reactive Hyperemia Ring Test in the Study, Evaluation and Prognosis of Pedal Lesions Caused by Arteriosclerosis Obliterans and Arterial Embolism , Am. Heart J. 24:345 ( (Sept.) ) 1942;.
14 +
DiPalma, J. R.; Reynolds, S. R. M., and Foster, F. I.:  Measurement of the Sensitivity of the Smallest Blood Vessels in Human Skin: Responses to Graded Mechanical Stimulation in Normal Men , J. Clin. Investigation 20:333 ( (July) ) 1941;.
15 +
DiPalma, J. R.:  Quantitative Alterations in the Hyperemic Responses to Local Ischemia of the Smallest Blood Vessels of the Human Skin Following Systemic Anoxemia, Hypercapnia, Acidosis and Alkalosis , J. Exper. Med. 76:401 ( (Nov.) ) 1942;.
16 +
DiPalma, J. R., and Foster, F. I.:  Sensitivity of the Smallest Cutaneous Blood Vessels: Quantitative Responses to Graded Mechanical Stimulation and to Local Ischemia in Arterial Hypertension, Arteriosclerosis and Certain Allied Disorders , J. Clin. Investigation 21:675 ( (Nov.) ) 1942;.
17 +
Reynolds, S. R. M.; Hamilton, J. R.; DiPalma, J. R.; Hubert, G. B., and Foster, F. I.:  Dermovascular Change: Dermovascular Actions of Certain Steroid Hormones in Castrate, Eunuchoid and Normal Men , J. Clin. Endocrinol. 2:228 ( (April) ) 1942;.

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