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March 18, 1939


JAMA. 1939;112(11):1057-1061. doi:10.1001/jama.1939.62800110009009

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Dr. McKeen Cattell:  In any consideration of the management of secondary shock, a knowledge of the signs and symptoms is an essential prerequisite. Theories of the causation of shock are numerous and diverse. Many of the characteristic changes associated with this condition have been satisfactorily explained. In general, these changes are progressive and serve as a guide to treatment and a measure of the severity of the condition.The syndrome of secondary shock when fully developed is characterized by the following features: low blood pressure, decreased blood flow, decreased blood volume, lowered temperature and lowered metabolism. Hemoconcentration is an important feature and results in high hemoglobin values. The blood sugar and nonprotein nitrogen are increased, chlorides are decreased and the carbon dioxide combining power is low.These changes are not all present in the beginning and for that reason the condition has commonly been divided into primary and secondary stages.

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