00:01
What about therapy? Well, there's a number
of therapies. First of all, you want to increase
the blood volume, because when the arterioles
dilate, they markedly increase the volume
of blood that's needed to fill the system.
So if it's a hemorrhage, you often give blood.
00:19
If it's a severe infection, we may give plasma—that
is, the fluid component of blood—or other
fluids to, in a sense, what we call "fill
up the tank." Also, there are pharmacological
agents that can be given that constrict the
arterioles and raise the peripheral vascular
resistance. For example, we can give adrenaline
or noradrenaline, which constricts the peripheral
arterioles, raises the resistance, and raises
the blood pressure.
00:48
We can even use mechanical devices, and there's
a whole array of mechanical devices. The one
that's best known and used very commonly is
the so-called intra-aortic balloon counterpulsation
device. You can see that a hotdog-shaped balloon
is inserted into the aorta, and it's attached
to a pump that pumps helium gas in and out
of the balloon (helium gas because it can
be very rapidly pumped in and out of the balloon).
Each time the heart contracts, the balloon
contracts. And each time the heart relaxes,
the balloon inflates. And what that does is
it increases blood pressure during diastole
and it helps move the blood out of the heart
during systole, so it increases cardiac output.
Well, there are a whole variety of small heart–lung
machines and a whole bunch of other equipment
that's used in very sophisticated intensive
care units that also help to maintain blood
pressure in patients with severe shock. It's
way beyond the level of specialization of
this talk, but it's important to know that
there's a whole variety of little pumps that
can be put on catheters, that can be inserted
into blood vessels, and that can help maintain
cardiac output and maintain blood pressure
while you're getting the patient over whatever
catastrophic illness has caused the shock
state.
It is important that urgent and aggressive
therapy be done early in the shock state before
there is serious damage to the heart, the
kidneys, and the brain. So, for example, a
patient who's having a large blood volume
loss from some injury: It's really important
to get blood transfusion in there to get the
blood pressure up. We often talk about, in
trauma, the golden hour: the first hour after
a serious injury where, let's say, an artery
has been cut and the patient's bleeding copiously.
02:45
If you get lots of blood into that patient
during the first hour, there's a very good
chance the patient will survive. If the blood
transfusions don't occur for several hours,
the chance of survival is much less.
And, of course, emergency surgery: Let's take
the trauma example. There's the patient, you
know, who is bleeding from a torn artery.
03:07
Obviously, the most important thing is to
get in there and repair that artery so that
you stop the bleeding. Or if there's a big
abscess in the abdomen, filled with bacteria,
that's putting bacteria into the bloodstream,
you need to get a surgeon in there to drain
that abscess and get all that pus and bacteria
out of the abdomen. And then, of course, you
have to use drugs as well: antibiotics and
so forth. So you have to treat the underlying
illness, and you have to treat aggressively
and early, as quickly as you can, both with
medicines and, when needed, with surgical
intervention.