Drug therapy of shock

Abstract

In shock, as in so many other pathological conditions, the development of effective therapy depends to a large extent on knowledge of etiology. Consequently, questions of treatment and of etiology cannot be discussed entirely in isolation. Our understanding of the shock process is still very inadequate, but one of the few points on which there is general agreement is that a decrease in effective circulating blood volume is a major contributing factor in most cases. This knowledge has made it possible for treatment by blood transfusion and other fluid volume replacement to develop much more rapidly and successfully than any other type of therapy of shock. This presentation will not cover the use of blood or other fluid and electrolyte preparations except as this relates to the use of “drugs” in a more restricted sense. However, I should like to begin my discussion by re-emphasizing that proper attention to intravascular volume should be the first consideration in the management of all cases of shock, and that it is the only type of treatment necessary in the majority. This principle is applicable to shock due to many different precipitating factors, but it obviously excludes shock associated with myocardial infarction.