NECROPSY studies of shocked patients have increased our understanding of the origin of intractable shock in human beings. Such studies have demonstrated that in man, a major lesion is present in most instances of intractable shock,1-3 Surgical removal or correction of this lesion can lead to the recovery of the patient.3
The major lesion may be defined as a major pathologic change in the tissues which is recognizable at necropsy. This lesion underlies the intractable shock state, and frequently, is also the cause of death. Examples of such lesions are massive hemorrhage, peritonitis, renal infection, bronchopneumonia, myocardial infarction, pulmonary embolism, and massive pulmonary edema.
Many major lesions are not amendable to correction or removal by surgical operation. Nevertheless, in a series of 169 patients dying in a state of intractable shock, postmortem examination later showed that 41% had major lesions which might have been removed or corrected by