In the handling of a patient with shock it is essential to identify the underlying cause in order to plan rational treatment. On the basis of information presently available, the specific causes of shock have been classified into 6 groups: hypovolemia, cardiac failure, bacteremia, hypersensitivity, neurogenic factors, and obstruction to blood flow. Treatment was discussed with reference to these groups.
Vasopressor agents are helpful in most instances of shock related to cardiac failure, bacteremia, and hypersensitivity. They usually are contraindicated in shock due to vascular obstruction and in hypovolemic shock until optimal replacement of fluid has been achieved. Recent studies have indicated that metaraminol may be the pressor amine of choice because it is therapeutically effective, simple to administer, without risk of injury to skin and subcutaneous tissues, and available for injection without additional fluid (thus especially suitable for patients with renal failure).
Rigorous attention to the fluid and electrolyte state is of special importance. In the presence of acidosis, the response to vasopressor agents is greatly diminished. The use of molar solution of sodium lactate to re-establish this responsiveness has met with limited success and seems worthy of trial in selected cases.
Adrenocortical hormones may be of striking benefit in shock due to bacteremia or hypersensitivity when an overwhelming response to inflammation threatens life. These drugs may be used also to augment the effectiveness of vasopressor drugs. Relatively little risk is involved, provided that the periods of employment are short and that antibiotics are used concurrently.
The indications for the use of digitalis glycosides in shock are the same as at other times, and their routine use is of no proved benefit and may be injurious. Atropine is of value when excessive vagal activity with bradycardia produces or complicates the hypotensive state.
Chlorpromazine is of no proved worth in the treatment of shock, and possible benefits achieved with anticoagulants are not established as yet. Preliminary observations suggest that hypothermia may be of some value. The head-down position provides only transient benefit in patients with shock, and its prolonged or routine use may delay recovery.
- © 1957 American Heart Association, Inc.