Cases reported "Shock, Hemorrhagic"

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1/3. Reversal by vasopressin of intractable hypotension in the late phase of hemorrhagic shock.

    BACKGROUND: Hypovolemic shock of marked severity and duration may progress to cardiovascular collapse unresponsive to volume replacement and drug intervention. On the basis of clinical observations, we investigated the action of vasopressin in an animal model of this condition. methods AND RESULTS: In 7 dogs, prolonged hemorrhagic shock (mean arterial pressure [MAP] of approximately 40 mm Hg) was induced by exsanguination into a reservoir. After approximately 30 minutes, progressive reinfusion was needed to maintain MAP at approximately 40 mm Hg, and by approximately 1 hour, despite complete restoration of blood volume, the administration of norepinephrine approximately 3 micrograms . kg(-1). min(-1) was required to maintain this pressure. At this moment, administration of vasopressin 1 to 4 mU. kg(-1). min(-1) increased MAP from 39 /-6 to 128 /-9 mm Hg (P<0.001), primarily because of peripheral vasoconstriction. In 3 dogs subjected to similar prolonged hemorrhagic shock, angiotensin ii 180 ng. kg(-1). min(-1) had only a marginal effect on MAP (45 /-12 to 49 /-15 mm Hg). plasma vasopressin was markedly elevated during acute hemorrhage but fell from 319 /-66 to 29 /-9 pg/mL before administration of vasopressin (P<0.01). CONCLUSIONS: Vasopressin is a uniquely effective pressor in the irreversible phase of hemorrhagic shock unresponsive to volume replacement and catecholamine vasopressors. Vasopressin deficiency may contribute to the pathogenesis of this condition.
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ranking = 1
keywords = animal
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2/3. Fatal and near-fatal animal bite injuries.

    Fatal and near-fatal maulings of humans by pit bulls have recently become a topic of major public concern, resulting in the passage of laws in some jurisdictions that make the owner of a pit bull criminally liable for manslaughter if his or her pet causes a human death. The authors recently investigated two cases in which children were fatally injured by pet dogs. In the first case, a 17-day-old girl suffered fatal abdominal injuries when attacked by a pregnant Siberian husky. A 2-year-old girl expired from neck wounds inflicted by a pit bull or a rottweiler or both. Because no expert would testify as to which dog caused the fatal injury, the owner of the animals was not charged under a statute which specified criminality only if a pit bull caused the fatal injury. We also examined a 12-year-old boy who attempted to pet a circus tiger; the animal grabbed his arm with its claws and bit off the arm at the shoulder. The arm could not be reattached, but the child survived. These cases and the differentiation of animal bites from other injuries will be presented.
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ranking = 7
keywords = animal
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3/3. Extensive gangrene of the bowel after haemorrhagic shock: a case report.

    A 20-year-old man presented with an acute abdominal condition within 15 hours after having sustained severe extra-abdominal injuries with associated hypovolaemic shock. At laparotomy virtually the whole bowel was found to be ischaemic and perforation had occurred at the site of maximum ischaemia. No trauma to the bowel, mesenteric vessels or any other abdominal organ was noted, and it was concluded that the ischaemia had resulted from a prolonged splanchic vasospasm in an attempt to compensate for hypovolaemic shock. The condition is well recognized in animals, but has rarely been recorded in humans. Early resuscitation of the shocked patient is mandatory in order to prevent not only renal shutdown but also mesenteric ischaemia. It is possible that some patients who suffer from 'irreversible shock' may develop endotoxaemia owing to the absorption of toxins from partially ischaemic bowel which does not proceed to frank gangrene.
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keywords = animal
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