HEMORRHAGIC SHOCK: DEFINITION AND CRITERIA FOR ITS DIAGNOSIS

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Abstract
An attempt is made to differentiate 3 major conditions which may develop from uncomplicated hemorrhages of variable duration and intensity. These and their suggested terminologies are as follows: (a) a simple hemorrhagic hypotension state, from which recovery is almost assured without treatment in the form of transfusions or infusions. (This is by definition: withholding of treatment is not suggested.) (b) More severe hemorrhages lead to an impending shock state with severe, sustained hypotension and consequent tissue anoxia. If uncorrected within a certain interval, (c) a 3d condition develops which is designated as the irreversible shock state. The existence of this state may not be recognized at its onset unless one looks for specific accompanying diagnostic criteria. Five such criteria, definitely diagnostic for the conditions under which shock was produced in this study, are discussed in detail. The transition from the impending to the irreversible shock state occurred during the 90-min. hypotension period (40 mm. Hg), usually during the last 15 mins. Two criteria (persistent decline of blood pressure below 40 mm. Hg relative hemoconcn.) permitted diagnosis of existing irreversible shock during the hypotension period. The other 3 criteria enabled this state to be recognized, if present, early in the post-reinfusion period. These 3 were: rapid heart rate in relation to the control heart rate; passage of bloody and fluid fecal material; and actual hemoconcentration. Most animals in irreversible shock revealed 3 or more of these diagnostic manifestations. There were a few borderline cases, however, in which irreversible shock prevailed but could not be diagnosed because none of the criteria were detected. These animals lived for long periods following the termination of the hypotension period and the reinfusion of all withdrawn blood.

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