"Early diagnosis and early adequate treatment" is a maxim which applies with particular emphasis to the shock syndrome. If impending shock could be suspected and treated effectively before changes in blood pressure and pulse sound the clarion call of approaching death, lives could be saved. Indeed it is even maintained by some observers that when the blood pressure falls and is maintained for an appreciable time below the so-called "critical level" and pulse changes are pronounced, a stage of shock has been attained which is frequently irreversible.1 Hence the need for simple clinical methods which provide a means of diagnosing impending shock at the earliest possible moment. To accomplish this many attempts have been made; to date not one remains so effective as a serial follow-up of blood pressure and pulse. Among the promising are studies of blood concentration. Unquestionably they are of value in the shock arising from
DiPALMA JR. THE CIRCULATION IN THE SKIN IN THE SHOCK SYNDROME: COMPARISON OF SIMPLE PROGNOSTIC FEATURES OF CLINICAL VALUE. JAMA. 1943;123(11):684–693. doi:10.1001/jama.1943.02840460018006
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