Treatment of Shock with Vasodilators Measuring Skin Temperature on the Big Toe: Ten Years' Experience in 150 Cases

Abstract

During the last ten years, more than 150 patients in shock who did not respond to conventional treatment have been treated with small doses of chlorpromazine and pethidine to create universal vasodilatation. Temperature measurement in the rectum and the skin temperature on the big toe was then a guide to the proper intravenous administration of fluids. The regimen has been conducted in airconditioned rooms where changes in temperature of the patient can only be related to changes in his condition due to disease or treatment. During vasoconstriction due to shock or administration of vasopressors, one can see 20 C difference between rectal temperature and skin temperature of the big toe. The patient cannot get rid of his heat because blood flow in the skin and subcutaneous tissue is so decreased that he cannot carry his heat to the body surface. When vasodilatation is achieved after the administration of chlorpromazine, the hemodynamic condition is characterized by a fall in rectal temperature and a difference between this and the skin temperature of only 3-4 C. In this condition, the patient cannot protect himself against heat loss and the rectal temperature will be dependent upon the temperature of the surroundings. The value of the regimen is its simplicity since only the following measurements are necessary: blood pressure, pulse, respiration, hourly urinary output, skin temperature of the big toe and rectal temperature. The filling of the external jugular veins can be observed and does not have to be measured.