Shock, hemorrhagic traumatic

Gibson JB, Maxwell RA, Schweitzer JB, et al. Resuscitation from severe hemorrhagic shock after traumatic brain injury using saline, shed blood, or a blood substitute. Shock 2002 17 234. 

Szab6, C., and Thiemermann, C. (1994). Review Role of nitric oxide in hemorrhagic, traumatic and anaphylactic shock and in thermal injury. Shock 2, 1-11. 

Szabo C, Thiemermann C. Role of nitric oxide in hemorrhage, traumatic, and anaphylactic shock and thermal injuiy. Shock 1994 2 145-55. 

Morphine releases histamine and may cause peripheral vasodilation and orthostatic hypotension (Figure 47.7). The cutaneous blood vessels dilate around the blush areas such as the face, neck, and upper thorax. Morphine causes cerebral vasodilation (due to increased carbon dioxide retention secondary to respiratory depression), and hence, it increases the cerebrospinal fluid pressure. Therefore, morphine should be used cautiously in patients with either meningitis or a recent head injury. When given subcutaneously, morphine is absorbed poorly whenever there is either traumatic or hemorrhagic shock. 

A major anticipated use of acellular Hb would be for the emergency treatment of patients with traumatic hemorrhagic shock. The probability of associated bacterial infections in this patient population is high. Thus, the potential for hemoglobin to potentiate or exacerbate bacterial infection has been discussed widely. 

Rhee P, Morris J, Durham R, Hauser C, Cipolle M, Wilson R, Luchette F, McSwain N, Miller R. Recombinant humanized monoclonal antibody against CD18 (rhuMAb CD18) in traumatic hemorrhagic shock results of a phase II clinical trial. J Trauma Inj Infect Crit Care 2000 49 611-619. 

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