pituitrin and Shock--Traumatic

The preclinical diagnosis of shock is still based on the patient's history, the physical examination, the injury pattern and a few hemodynamic parameters available in the emergency set-up. The clinical picture is characterised by hypotension and tachycardia, tachypnoe and dyspnoea as well as cerebral impairment. Results from recent clinical trials indicate, that a adapted and specific therapeutic approach for the various shock forms is necessary. In case of traumatic hypovolemic-hemorrhagic shock it is of particular relevance if penetrating trauma and/or uncontrolled bleeding exists. Under these conditions an immediate definite surgical treatment is required ("scoop and run") and a moderate hypotension should be tolerated. ("treat and run"). Fluid substitution and therapy with catecholamines should be used conservatively. In all other forms of shock the treatment approach can and should be more aggressive in order to improve microvascular perfusion as early as possible. Besides adequate fluid resuscitation in a combination of crystalloid and colloid solutions catecholamines and-under specific circumstances-also vasopressin should be used. Of utmost importance in the pre-clinical management of patients in shock is the optimal selection of the centre that the patient is referred to in order to establish the fastest and best possible definite treatment for the patient.

Topics: Catecholamines; Combined Modality Therapy; Emergency Medical Services; Fluid Therapy; Humans; Monitoring, Physiologic; Prognosis; Resuscitation; Shock; Shock, Hemorrhagic; Shock, Traumatic; Trauma Centers; Vasopressins

Changes in hormonal regulation of the vascular tone in Wistar rats were studied on Cannon model of traumatic shock. The pressor response to angiotensin II decreased by 30-40% 3 h after the incidence of trauma. The reaction to vasopressin remained unchanged. However, phenylephrine in medium and high doses produced a more pronounced pressor response under these conditions. One day after trauma we revealed a decrease in vascular sensitivity not only to angiotensin II, but also to vasopressin and alpha1-adrenoceptor agonist phenylephrine. The vascular response was observed only after treatment with phenylephrine in maximum doses. Traumatic shock was accompanied by inverse response to serotonin: hypertensive effect instead of blood pressure drop. Our results show that traumatic shock is accompanied by specific changes in vascular reactivity.

Topics: Angiotensin II; Animals; Blood Pressure; Dose-Response Relationship, Drug; Male; Phenylephrine; Rats; Rats, Wistar; Serotonin; Shock, Traumatic; Time Factors; Vasoconstrictor Agents; Vasopressins

Eight burn patients with smoke inhalation were studied. High levels of plasma vasopressin and plasma cortisol in the presence of polyuria were observed. Stress and pain seem to be the main factors in the vasopressin oversecretion; the polyuria probably resulted from fluid administration and osmotic diuresis.

Topics: Burns; Humans; Hydrocortisone; Polyuria; Shock, Traumatic; Vasopressins

Topics: Acute Kidney Injury; Aldosterone; Animals; Anuria; Burns; Diabetes Insipidus; Disease Models, Animal; Diuresis; Diuretics; Furosemide; Kidney; Male; Mineralocorticoid Receptor Antagonists; Rats; Shock, Traumatic; Sodium; Sodium Chloride; Time Factors; Urea; Vasopressins; Water

Topics: Adaptation, Physiological; Angiotensin II; Animals; Blood Pressure; Catheterization; Female; Intestine, Large; Ischemia; Mononuclear Phagocyte System; Norepinephrine; Phagocytes; Phagocytosis; Rats; Shock; Shock, Hemorrhagic; Shock, Traumatic; Vasopressins

Topics: Angiotensin II; Animals; Blood Pressure; Female; Intestines; Ischemia; Mononuclear Phagocyte System; Norepinephrine; Phagocytosis; Rats; Shock, Hemorrhagic; Shock, Traumatic; Sodium; Vasopressins

Topics: Angiotensins; Arginine Vasopressin; Endotoxins; Felypressin; Intestinal Diseases; Ischemia; Norepinephrine; Pharmacology; Rats; Research; Shock, Septic; Shock, Traumatic; Vasoconstrictor Agents; Vasopressins