Emergency War Surgery NATO Handbook: Part II: Response of the Body to Wounding: Chapter IX: Shock and Resuscitation

Introduction

United States Department of Defense

One encounters multiple classifications of the shock syndromes. The common denominator in all forms of shock is inadequate capillary perfusion. This chapter concerns itself with the diagnosis and treatment of hemorrhagic shock, that clinical state in which the capillary perfusion is inadequate to satisfy tissue requirements as a result of the loss of blood. For the sake of completeness, we will briefly mention the other forms of shock:

1. Septic Shock -This syndrome results from the absorption of bacterial toxins or toxic products from infected muscle or other tissues in which debridement has not been performed or was performed inadequately. Massive infection of serous cavities especially predisposes to this potentially catastrophic complication.

2. Neurogenic Shock - Neurogenic shock results from autonomic nervous system stimulation, causing either widespread vasodilatation or the inhibition of vasoconstriction. This can result in vascular collapse. Neurogenic shock may occur after head injury, may be brought on by pain, or may occur on an emotional basis. The pulse is slow, usually around 60/minute. The syndrome is most often encountered in the operating room in association with the rise of certain pharmacologic agents.

3. Oligemic Shock - Oligemic shock, like hemorrhagic shock, results from loss of circulation volume. The volume loss in this situation usually results from severe, unreplaced, nonhemic losses, such as those arising from severe vomiting or diarrhea. ileus, intestinal obstruction, or enteric fistulas. Loss of plasma by seepage, as occurs with but us, intestinal infarction, and crush injury also results in external or extravascular "third spaces" losses.

The combat surgeon should bear in mind that the most common cause of death on the battlefield and during evacuation to the hospital is exsanguination. Hemorrhagic shock is far and away the most commonly encountered shock syndrome. Experience has also shown that the majority of casualties, presenting in advanced shock will require Surgical intervention to achieve hemostasis before stabilization and hemodynamic improvement can be achieved and maintained.

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Operational Medicine 2001

Health Care in Military Settings

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