Management of refractory shock

The one feature that characterizes all shock, regardless of its cause, is a reduction in the effective circulating blood volume. The reduced blood volume leads to decreased venous return, decreased cardiac output, vasoconstriction, tachycardia, hypotension, tissue anoxia and death if the sequence of events is uninterrupted. Immediate therapy must be directed at restoration of the blood volume, preferably with whole blood. Infection must be controlled by use of antibiotics intramuscularly and intravenously. If shock persists, aqueous adrenal extract should be administered in large quantities. As a last resort, a vasopressor should be tried.