Recent Advances in Haemorrhage and Shock

Oliguric Renal Failure of Surgical Origin

“…Prolonged hypotension, a direct result of injury (Clarke, 1957), was thought to have been responsible for the development of acute intrinsic renal failure in the eight patients with multiple fractures without visceral injury, the four patients with pelvic fractures and rupture of the posterior urethra or extraperitoneal rupture of the bladder, and the two patients with extensive burns; myoglobin (Bywaters and Dible, 1942) Treatment of Extrinsic Renal Failure * No useful purpose would be served by recording a detailed acount of the treatment, by blood transfusion, water and electrolyte replacement, used in the four patients with pre-renal extrinsic renal failure and the 23 patients with post-renal obstructive failure: it varied from case to case, although it was always based on regular clinical, biochemical, and haematological observations. The patients were seen at least once a day and repeated, usually daily, biochemical observations were made not only on the blood but also on the urine and, when required, on gastro-intestinal aspirate.…”

The Role of Halothane in the Prevention of Surgical Shock

“…These reviews indicate that most of the work to date has been done by surgeons, physicians, and physiologists who have proved conclusively that the maintenance of the blood volume is the most important single factor in the prevention and treatment of shock. Clarke (1957) suggested that the failure of response to blood transfusion was due mainly to too little blood too late. The rapid intravenous infusion of large amounts of blood has been shown to cause acute right-sided heart failure secondary to the intense vasoconstriction of the pulmonary arterioles caused by the citrate used to prevent coagulation of the stored blood, a reaction which can be prevented by the intravenous administration of calcium gluconate and procaine hydrochloride (Firt and Hejhal, 1957).…”