THE IMMEDIATE concern in any case of acute poliomyelitis is the treatment and management of two systems, namely, the cardiovascular and the respiratory. It is through the involvement of these systems that death ensues, even though the actual pathology may be confined to the central nervous system. As stated by Plum and Wolff1:
In our experience, arrhythmias and shock due to failure of neurogenic cardiovascular regulation proved unresponsive to therapeutic measures, such as administration of the digitalis glycosides or phenylephrine (neo-synephrine®) and parenteral injection of fluids. In contrast to the discouraging prognosis offered by circulatory failure, the ill effects of respiratory insufficiency could often be prevented or reversed, and therefore the maintenance of a physiologic respiratory exchange was given primary attention.
Most of the signs, characterizing what we will later refer to as the encephalitic type, could and probably do result from hypoxia (low oxygen tension) and hypercapnia (high
ALLEN JE, BLASE CS. TRACHEOTOMY IN POLIOMYELITIS. AMA Arch Otolaryngol. 1954;59(5):571–574. doi:10.1001/archotol.1954.00710050583008
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