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 2024/04/24
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.