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August 2, 1971

Treatment of Shock

Author Affiliations

Old Bridge, NJ

JAMA. 1971;217(5):697. doi:10.1001/jama.1971.03190050153021

To the Editor.—  The excellent case report on "Fatal Heat Stroke" by Graber et al (216:1195, 1971) prompts me, as a monday-morning quarterback, to offer two suggestions. First, in the presence of a definite or suspected diagnosis of disseminated intravascular clotting, a search for fibrin split products in the circulation is imperative. If found, heparinization should precede administration of blood to prevent clotting of the fresh blood by the fibrin split products. In the protocol, fresh blood appears to have headed the therapeutic regimen, and heparin brought up the rear.Second, there was no mention of the use of steroids. In an excellent review of the treatment of endotoxin shock, Hodes presented seven reasons for the use of steroids in these cases.1 He stated that cortisone must be administered in very large, pharmacologic doses, and advised intravenous use of hydrocortisone in a dose of 35 to 50 mg/kg