Knisely, M. H.; Cowley, R. A.; Hawthorne, I.; Garris, D.
December 1970
Angiology;Dec1970, Vol. 21 Issue 11, p728
Academic Journal
Human blood donors, bled from 300 to 800 cc. of blood, responded by contraction to obliteration of arteries, arterioles, capillaries, postcapillary venules and venules of the bulbar conjunctiva. For the first hour, erythrocyte aggregation did not develop. Dogs bled more severely down to 30 mm./Hg arterial pressure exhibited contraction of from 50 to 80% of all previously visible vessels in conjunctiva, surface of testis, and inner surface of elbow bursae. After a time, blood cell aggregates began to appear in blood flowing through the few vessels which remained patent. The major blood flow reducing phenomenon in the hemorrhagic shock patients was the contraction of large numbers of vessels tightly shut so that flow occurred in very few of them. In contract, the major blood flow reducing phenomenon in the septic shock patients was the massive agglutination of the blood cells with their visible resistance to passage through vessels, the loss of the ability of the walls of small vessels to retain blood plasma fluids, with the consequent progressive hemoconcentration of passing blood cell masses, and the massive impaction and plugging of vessels with concentrated sludge. The significance of the above observations are discussed. Three items are: (1) Reduced rates of flow of blood containing bacteria into minute areas of the liver and spleen necessarily reduces the number of bacteria which can be brought to splenic and hepatic phagocytes per hour. This and other factors presented in the discussion increase the probability that the patient develops an overwhelming infection. (2) The forced reduction, even stopping, of blood flow through minute areas of the central nervous system of patients in shock, particularly septic shock, probably are major contributing factors of the lack of alertness, various types of confusional states, obsessive behavior, violence and complete unconsciousness exhibited by various patients. (3) Hemorrhagic shock and septic shock necessarily need different types of therapy, although in practice these may be overlapping. Open, dilated vessels, including terminal arterioles, capillaries and venules, and unagglutimated blood, which together permit adequate perfusion of tissues, are both necessary, simultaneously, for survival. The above experiments and items discussed can be used to guide experimental therapy in animals and to test in the human Shock Trauma Unit some of the direct effects and relative effectiveness of therapies now in use, and others, when each is ready for human testing.


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