FLUORESCEIN CIRCULATION TIME AS A PROGNOSTIC SIGN IN EXPERIMENTAL TRAUMATIC SHOCK

Repeated determinations of the circulation time by the fluorescein method were made in normal and shocked dogs. In normal animals the circulation time ranges from 9 to 16 seconds with an average of 12.6 seconds. In traumatic shock the circulation time is invariably prolonged. For prognosis in the traumatized animal two determinations of fluorescein circulation time separated by an interval of 1 hour are essential. If the second circulation time is longer than the first and both are over 30 seconds, the animal will not survive without therapy. On the other hand, if the second circulation time is below 25 seconds or is considerably shorter than the first, the prognosis is good. In many of these experiments the change in circulation time appeared to be the earliest index of eventual recovery or death. It gave a clue to the fate of the animal when no decisive judgment could be made from the blood pressure and heart rate. In three dogs the cyanide and fluorescein circulation times were compared during shock. It was found that the cyanide circulation time, though increased in shock, remained at a fairly constant value while over the same period the fluorescein circulation time showed progressive changes. This discrepancy between the cyanide and fluorescein methods may be explained by the fact that the former does not include the minute peripheral systemic circulation. Since the study of shock is concerned with tissue anoxia and is primarily a phenomenon of the failure of the peripheral circulation, it is important to choose procedures such as the fluorescein method as a measure of the condition of the peripheral vascular system.