STUDIES ON THERAPY IN TRAUMATIC SHOCK

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Abstract
A procedure is described that leads to "shock" with its characteristic manifestations of drop in blood pressure, hemoconc.. loss of plasma protein and further in the death of 97-98% of the dogs subjected to it. The tourniquets must be applied not only to shut off the circulation of the hind legs but tightly enough actually to damage the underlying soft tissues. The processes active in the damaged tissues during the 1st hr. after the restoration of the circulation, including the local loss of fluid, are adequate to initiate fatal shock. Interference with these by taping the legs 1 hr. after the release of the tourniquets is followed by a slightly longer survival period but not by increased recovery. Therapy may be instituted at the end of 1 hr. after the release of the tourniquets on the hind legs. Restoration of the fluid content of the body by intraven. infusion of saline increases the survival period to 100% but leads to recovery only in 1 of 10 animals. Intravenous infusion of dog-plasma-albumin of a colloid-osmotic pressure equivalent at least to that of the total plasma further prolongs the survival period but does not influence recovery. Globulin preps. of 5% conc. from dog-plasma are not as effective as saline. Only 1 dog of 9 recovered. Citrated dog-plasma led to complete re-? covery in 14 of 18 dogs. Three of 4 animals that died showed adequate other cause than shock for death. Dog-plasma dialyzed as described is no longer effective as a therapeutic agent. Dog-plasma alkalinized and readjusted to the original H conc. is no longer effective therapeutically. Methylene blue administered intraven. promptly raises the blood pressure of an animal in shock. As a supplement to intraven. saline infusion it neither increases survival time nor % recovery. Methylene blue as a supplement to dog-plasma albumin infusion prolongs the survival period and raises recovery rate to 42%. Na succinate, injected intraven., is followed temporarily by more forcible and more regular cardiac action. As a supplement to saline infusion it results in a recovery of 43% of the animals. The beneficial influence of succinate contrasts to the known ineffectiveness of glucose. This may indicate a definite disturbance in the earlier stages of the carbohydrate breakdown. It is not known whether the P turnover is involved. The therapeutic value of plasma is not fully explained by its colloidal osmotic pressure. The search for labile substances that restore tissue metabolism is indicated.

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