The Metabolism of Traumatic Shock 



JOSEPH C. AUB 



BOSTON 



Traumatic shock is an acute, abnormal state which must always be 

 of interest to the surgeon, net because of its frequency, but because of 

 its serious prognosis. Its frequency, as seen upon the battlefield, prob- 

 ably explains the large amount of study upon the subject which accom- 

 panies each war ; and yet the condition is not an unusual accompaniment 

 of .civil life. For example, the surgical statistics of five representative 

 hospitals for five years show that 19 per cent of the total 2,703 deaths 

 were complicated by "shock." 



''" Traumatic shock may be divided into two types. There is primary 

 'shock, which appears promptly after the accident or trauma. It is most 

 often seen after abdominal or cranial injuries, and, while its appearance 

 is quite similar to that seen in secondary traumatic shock, its onset is 

 prompt, its cause probably in the central nervous system, and its prog- 

 nosis very grave. Very little is known of this form of shock; the onset 

 is so rapid and the condition so serious that it is. a difficult state to study. 

 Much more is known about secondary traumatic shock. This usually de- 

 velops gradually some time after the trauma, and it is most often asso- 

 ciated with wounds involving large muscle masses. 



The characteristic picture of shock is a patient lying quietly, or 

 mildly restless, usually with dulled mentality, and with slow reaction 

 time, and frequently not conscious of much pain. The face is pale, 

 with a dusky pallor, sunken eyes, and drawn expression. Respiration is 

 slightly increased in rate, superficial in volume, and made irregular by 

 occasional deep sighs. The pulse is rapid, very soft, and often difficult to 

 obtaiii. A low blood pressure is the most distinguishing feature of the 

 condition. It is, usually, almost a quantitative index of the severity of 

 the shock, falling in very severe cases as low as 50 mm. Hg systolic, or 

 even so low. that it is impossible to feel the pulse or hear the impulse in 

 the arm. The/body temperature is also reduced, frequently to 94 or 95 

 <F., and even'to 87.8 F. in spinal cord injuries. The surface of the 

 Jbody is cold and is usually drenched with perspiration. Indeed, the 

 .Whole appearance is one very closely resembling severe hemorrhage, or an 



253 



