RT Book, Section A1 Stewart, Barclay T. A1 Maier, Ronald V. A2 Feliciano, David V. A2 Mattox, Kenneth L. A2 Moore, Ernest E. SR Print(0) ID 1175131760 T1 Management of Shock T2 Trauma, 9e YR 2020 FD 2020 PB McGraw Hill PP New York, NY SN 9781260143348 LK accesssurgery.mhmedical.com/content.aspx?aid=1175131760 RD 2024/10/04 AB KEY POINTSIn shock, there is an imbalance between substrate delivery (supply) and substrate requirements (demand).In the neuroendocrine response to shock, the hypothalamus releases corticotrophin-releasing hormone, causing pituitary release of adrenocorticotropin hormone followed by adrenal cortex release of cortisol.Shock-activated neutrophils and their products may produce bystander cell injury and organ dysfunction.Because it is difficult to measure oxygen debt during resuscitation of trauma patients, surrogate parameters such as base deficit and serum lactate are measured.Crystalloid solutions pass relatively freely across the vascular endothelium and damaged endothelial glycocalyx layer in shock, and this can result in pronounced expansion of the extracellular fluid compartment.Lyophilized plasma is compatible with all blood types and can be stored at room temperature for up to 2 years, and its reconstitution requires less than 6 minutes.The principles of damage control resuscitation are permissive hypotension, restriction of crystalloid resuscitation, earlier blood and component resuscitation in appropriate ratios, and goal-directed correction of any coagulopathy.Exceptions to damage control resuscitation include elderly patients and those with traumatic brain injuries.Viscoelastic assays of coagulation such as thromboelastography and rotational thromboelastometry are now commonly used to correct any coagulopathies during resuscitation.Forms of shock include hypovolemic, neurogenic, cardiogenic, septic, obstructive, and traumatic.