A brief history of shock

Abstract

RECENTLY, 2 MIDDLE-AGED COUSINS were admitted to the Level I trauma center where I attend as a trauma surgeon. Each had been shot twice. Their wounds were similar; both suffered a single gunshot wound to the epigastrium and a second wound in the left flank. The first cousin (let us call him Joe), had a normal pulse and blood pressure and was oriented and composed; his skin was pink and dry. The second cousin (let us call him Frank) was hypotensive and tachycardic; he was apathetic and disoriented, although paramedics reported that he had been agitated and combative in the field just minutes before. His skin was pale and he was diaphoretic. There was 1 operating room immediately available and 1 that would be ready in 20 minutes. Frank was given priority. At surgery, he was found to have a bullet track passing through the left lobe of the liver, the gastric antrum, the pancreatic neck, and the splenic artery. There were $2 L of blood in his abdomen. Joe was found to have a bullet track that passed through the right lobe of the liver (nonbleeding) and through the hepatic flexure of colon. He had 140,000 citations. The meaning of the term ‘‘shock’’ varies depending upon the