Traumatic shock

Among the biochemical reactions that anino acids undergo is decarboxylation to fflnines. Decar boxylation of histidine, for example, gives histamine, a powerful vasodilator nonnally present in tissue and fonned in excessive fflnounts under conditions of traumatic shock. 

Thromboxane A-2 has been implicated in a number of disorders of the circulatory system including coronary artery spasms, unstable angina pectoris, traumatic and endotoxic shock, and heart attacks. It is formed normally very near its receptors and is rapidly deactivated by metabolizing enzymes so circulating levels are quite low. Furthermore, it is opposed in its actions by the prostacyclins. When these controls are defective, pathology results and drugs can be the resort in attempts to restore the normal healthy balance. For one example, furegrelate (6) is a throm-... 

Patients who have suffered traumatic injuries must receive an immediate intravenous solution to combat the symptoms of shock and help maintain the pH of blood. 

Recendy, PEN, a-4-pyridyl-oxide-N-t-butyl nitrone (POEN) or 5-5,dimethyl-1, pyrroline-N-oxide (DMPO) were evaluated in models of experimental shock (endo-toxic, traumatic and mesenteric artery occlusion in rats). All three nitrones, when given prior to the insult intraperitoneally, were protective. When the nitrone s spin trapping ability was inactivated by exposure to solar light and air, they were no longer efficacious (Novelli, 1992). 

The terror of this experience with her father along with her mothers refusal to help her, forced young Cathy to dissociate from these events by creating an entirely new personality, to deal with her father. Traumatic events in one s life can create a repressed memory or a condition of shock so severe that the victim becomes incapable of living with it on their own. In O Brien s case she discovered her family s perverted and abusive sexual history during her upbringing, but since that was all she knew, the acceptance of ritual abuse was sadly became the norm. 

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. 

Seligman ME, MaierSF. Failure to escape traumatic shock. J Exp Psychol 1967 74 1-9. 

Chronic adrenocortical insufficiency is characterized by weakness, fatigue, weight loss, hypotension, hyperpigmentation, and inability to maintain the blood glucose level during fasting. In such individuals, minor noxious, traumatic, or infectious stimuli may produce acute adrenal insufficiency with circulatory shock and even death. 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

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. 

If a person has undergone a very abrupt and acute break with reality, it can be very helpful to examine the precipitating trauma. The trauma may be culture shock for a student visiting from another country. It may be the death of a loved one. It may be an ongoing abusive relationship that restimulated the effects of even worse abuse in childhood. Life stories, and the traumatic events that abound in them, are infinitely varied. 

Several picrotoxane-containing plants are used in traditional medicines. Cor-iaria species play an important role in Chinese traditional medicine, notably against mental diseases. Coriaria nepalensis is used against numbness, toothache, traumatic injury, and conjunctivitis (252). In the traditional medicine of Taiwan, gastrointestinal disturbances, rheumatism, and uterine cancer are treated with extracts of Coriaria intermedia (255). C. sinica is used for treatment of schizophrenia (29), and extracts of the parasitic plant on C. nepalensis, L. parasiticus, were used as shock therapy in schizophrenia (27). Okuda et al. point to corianin (21) as the main active component (27). 

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. 

Better OS. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990 322 825-828. 

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