TRAUMATIC SHOCK. VIII. STUDIES IN THE THERAPY AND HEMODYNAMICS OF TOURNIQUET SHOCK 1

Abstract

The application of tourniquets to both hind legs of unanesthetized dogs for 5 hrs. is not always followed by shock. If shock occurs it is of moderate intensity. Saline soln. given intra-ven. is curative. The application of tourniquets to unanesthetized dogs for 8-11 hrs. will uniformly produce shock which is fatal if untreated. Intraven. administered plasma, 5% bovine albumin in saline soln., or 25% bovine albumin supplemented by peroral fluid are effective therapeutic agents, if the deficiency in plasma vol. is made good while the blood pressure is above 60 mm Hg. Occasionally they may be effective at blood pressures between 60 and 40 mm Hg. Physiologic saline, 25% albumin without peroral fluid, and 5% saline with peroral water are not effective. The critical blood pressure level of tourniquet shock is much higher than that of hemorrhagic shock. This may be related to the deleterious effect on cardiac output of the increased blood viscosity of tourniquet shock. Consequently, the high viscosity requires that plasma or plasma substitutes rather than whole blood be the agent of choice for blood vol. replacement therapy. Effective therapy is always accompanied by a substantial reduction in hematocrit and usually by a substantial restoration of the deficiency in plasma vol. The course of events following ineffective though adequate blood vol. replacement therapy of tourniquet shock is not materially altered by the adm. of succinic acid. Cure of 5 hr. tourniquet shock attributed by other investigators to succinic acid is achieved by saline therapy alone in expts. in which anesthesia is omitted. It is therefore apparent that any value succinic acid may have demonstrated in studies by other investigators is attributable to its ability to counteract the depressing effects of barbiturates.