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(Circulation. 1962;26:445.)
© 1962 American Heart Association, Inc.

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Shock: A Semantic Enigma

ROBERT F. RUSHMER M.D.¹; ROBERT L. VAN CITTERS M.D.¹; DEAN L. FRANKLIN ¹; Donald Baker ¹; William Schlegel ¹; Donald Harding ¹; Nolan Watson ¹; Raymond Smith ¹

¹ From the Department of Physiology and Biophysics, University of Washington School of Medicine, Seattle, Washington.

The first step in analyzing any clinical problem must be the identification and precise definition of the entity. An adequate definition must be based on accurate and quantitative description in terms of crucial variables. Since many of the essential variables can be measured or estimated on patients, shock can be approached in a series of logical steps for each type:

1. A discrete clinical condition currently classified under the term "shock" could be identified.

2. A specific and unique name and definition of this condition could be derived by direct and quantitative measurements of variables such as those represented in figure 1.

3. The initiating factors would become apparent from these measurements.

4. The compensatory reactions that are inadequate should be distinguished from responses that are inappropriate.

5. With this knowledge at hand, a suitable model of the circulatory disturbance could be evolved and validated by quantitative measurements in experimental analysis.

6. Appropriate therapy of the defined condition could then be based on knowledge of the nature of the basic disturbance. Obviously, treatment that would effectively correct the fundamental defect from extravasation or anaphylaxis might be dangerous if applied to a patient with myocardial infarction.

7. The terminal events in fatal shock-like states can be regarded as a group of potential vicious circles that may have no obvious connection with the original cause of the systemic arterial hypotension. Effective therapy during the final stages of circulatory deterioration requires a great deal more knowledge regarding the various mechanisms of circulatory collapse than we now possess.

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