The Fundamental Mechanisms Of Shock

Research, to which so much discussion and thought will be devoted at this symposium, appears to have been downgraded in our society. Yet, learning and education per se rank high in our set of values, from the point of view of both lay people and profes sional workers. For some reason, we fail to detect the illogic inherent in this value system--for, what is research but the learning of new information? Apparently our society associates "learning" only with known, long-gathered information. This symposium, I believe, will generate new information about shock through the integration of knowledge of many investi gators, who have come to share a common meeting ground. Hopefully, the worth of this and similar endeavors will gain the recognition and, more important, the support of the public. In the next decade or so, I believe that shock research workers will be channeling their efforts more and more into investigating the repair of damaged cells. The individual cell and its products must be scrutinized just as carefully as we examine the whole organism or its collections of cells. Shock is an exciting area of research, but it involves years of painstaking work. Moreover, the society which will reap its fruits must be persuaded to share the burden of its support. John A. Sehilling~ M.D. lAbstracted from Dr. John A. Schilling's Opening Statement at the symposium on October I, 1971.

Historically, 20% of all injured combatants die on the battlefield before they can be evacuated to a field hospital. Blood lossâ€"hemorrhageâ€"is the single major cause of death among those killed in action whose lives might otherwise be saved. Fluid resuscitation and the treatment of hypovolemia (the abnormally decreased volume of circulating fluid in the body) offer the greatest opportunity for reducing mortality and morbidity associated with battlefield casualties. In Fluid Resuscitation, a committee of experts assess current resuscitation fluids and protocols for the treatment of combat casualties and make recommendations for future research. Chapters focus on the pathophysiology of acute hemorrhagic shock, experience with and complications of fluid resuscitation, novel approaches to the treatment of shock, protocols of care at the site of injury, and future directions for research. The committee explicitly describes the similarities and differences between acute medical care during combat and civilian emergency trauma care. Fluid Resuscitation should help energize and focus research in both civilian and military emergency care and help save the lives of citizens and soldiers alike.

The first edition of this publication was aimed at defining the current concepts of trauma induced coagulopathy by critically analyzing the most up-to-date studies from a clinical and basic science perspective. It served as a reference source for any clinician interested in reviewing the pathophysiology, diagnosis, and management of the coagulopathic trauma patient, and the data that supports it. By meticulously describing the methodology of most traditional as well as state of the art coagulation assays the reader is provided with a full understanding of the tests that are used to study trauma induced coagulopathy. With the growing interest in understanding and managing coagulation in trauma, this second edition has been expanded to 46 chapters from its original 35 to incorporate the massive global efforts in understanding, diagnosing, and treating trauma induced coagulopathy. The evolving use of blood products as well as recently introduced hemostatic medications is reviewed in detail. The text provides therapeutic strategies to treat specific coagulation abnormalities following severe injury, which goes beyond the first edition that largely was based on describing the mechanisms causing coagulation abnormalities. Trauma Induced Coagulopathy 2nd Edition is a valuable reference to clinicians that are faced with specific clinical challenges when managing coagulopathy.

Handbook of ICU Therapy provides rapid access to important information on the treatment of the critically ill patient. It comprises a series of 'cutting edge' reviews of the most advanced treatment concepts available in the modern ICU. Whilst assuming a basic knowledge of underlying conditions, it nonetheless outlines key physiological principles where necessary, and critically reviews current literature and best practice. The heart of the book is aimed at providing key practical information on treatment techniques to the busy clinician in an easily accessible style. In addition to conventional drug therapy, ventilator, fluid and physical therapies are also discussed in detail. All of the authors are directly involved in ICU research and practice and are familiar with all of the latest developments in this fast-moving field of medicine.