RESUMO
The Army has had extensive experience in the study and treatment of shock, beginning with the American Civil War and continuing to the present. This is the story of one Army surgeon's experience, both in research and treatment of shock, from Pearl Harbor to the present.
Assuntos
Medicina Militar/história , Militares/história , Choque Traumático/história , Ferimentos e Lesões/história , História do Século XX , História do Século XXI , Humanos , Estados UnidosRESUMO
BACKGROUND: The low pO: (2) in traumatic and septic shock was first documented at Walter Reed Army Medical Center starting in 1960. It was postulated that this respiratory failure was due to the occlusion of the pulmonary microcirculation by the microclots of disseminated intravascular coagulation (DIC). MATERIALS AND METHODS: Animal studies showed that pulmonary failure and death could be caused by intravenous injection of a killed culture of either Escherichia coli or pneumococcal organisms or by severe muscle contusion. Severe clinical septic and traumatic shock cases were studied. RESULTS: Injection of either killed E. coli or killed pneumococci resulted in acute respiratory distress syndrome (ARDS) and death in pigs. Muscle contusion also resulted in ARDS and death in pigs. Both ARDS and death were prevented by administration of a plasminogen activator, and ARDS in human septic or traumatic shock were safely and effectively treated by administration of a plasminogen activator. CONCLUSIONS: Acute respiratory distress syndrome can be caused by DIC, which blocks the microcirculation of any and all organs. These microclots can be safely lysed by a plasminogen activator, thus treating ARDS and saving lives.
Assuntos
Síndrome do Desconforto Respiratório , Animais , Modelos Animais de Doenças , Coagulação Intravascular Disseminada/complicações , Cães , Humanos , Ativadores de Plasminogênio/uso terapêutico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Síndrome do Desconforto Respiratório/prevenção & controle , Sepse/complicações , Choque Traumático/complicações , Suínos , Resultado do TratamentoRESUMO
The association of shock with trauma has long been recognized. There are three types of shock, i.e., (1) hypovolemic or hemorrhagic shock, (2) traumatic shock, and (3) septic shock. The conditions and their treatments are described.
Assuntos
Medicina Militar , Choque Traumático/fisiopatologia , Guerra , Humanos , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/terapia , Choque Séptico/fisiopatologia , Choque Séptico/terapia , Choque Traumático/terapiaRESUMO
The treatment of wounds has received considerable attention from the time of the Trojan War. However, it was not until the American Civil War that shock was described as an entity distinct from the wounds themselves and that efforts were directed at more than just treatment of the wound. The need for fluid resuscitation in the treatment of hemorrhagic shock was first recognized in the Spanish American War, as was the association of sepsis with shock. World War I showed the need for blood in the treatment of "wound shock," a lesson that had to be relearned in World War II through bitter experience. Studies in the Korean War described the concept of disseminated intravascular coagulation and multiple organ failure, and the existence of disseminated intravascular coagulation was confirmed by studies in Vietnam. The treatment of hemorrhagic shock is now very effective, but the treatment of traumatic and septic shock remains unsatisfactory.
