SHOCK, as it is produced in the laboratory, usually involves a clearly identified set of initiating circumstances which range from hemorrhage, bowel ischemia, muscle trauma, to overt infection. For this reason, the general course of the syndrome is much more easily defined in terms of specific factors than is the shock state in man. Once shock is established, numerous contributory factors become involved with time and progressively undermine the capacity to respond to restorative measures. It is this aspect of the problem which continues to be controversial. The fact that biologically active agents appear in the tissues and in the blood stream coincidentally with the development of irreversibility, strongly suggests that the unremitting deterioration of cardiovascular function characteristic of severe, protracted shock may be due to the untoward action of one or more of these agents.
A logical first step in analyzing this aspect of the problem would be to
Zweifach BW. Tissue Mediators in the Genesis of Experimental Shock. JAMA. 1962;181(10):866–870. doi:10.1001/jama.1962.03050360052010
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