The problem of managing hemorrhagic shock has always been a challenge to the physician. As early as the turn of the century this condition was recognized, and during each of the great wars signal advances were made in its treatment. Heretofore blood pressure and pulse rate have been the primary clinical parameters observed in patients with hemorrhagic shock. Ancillary observations have also been recorded on skin temperature, sweating, and skin color. Laboratory tests, including hemoglobin, red blood cell count, hematocrit, and blood volume have been helpful in judging blood replacement therapy. The state of irreversible shock has received much discussion in the literature and was attributed for many years primarily to failure of the peripheral circulation with capillary paralysis and pooling of peripheral blood.
Recently the heart has been strongly implicated as the organ which determines irreversibility in shock whether caused by hemorrhage of other etiologies. Unfortunately, even the experimental
COOLEY JC, McINTOSH CL. Myocardial Contractile Force in Experimental Hemorrhagic Shock: Some Observations. Arch Surg. 1963;87(2):330–340. doi:10.1001/archsurg.1963.01310140138022
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