Surgical Shock


from Dr GK Abbott's Prescriptions...

see Collapse and Cardiac Excitant

Is always due to deranged vasomotor mechanisms not to the heart, or to loss of body fluids through haemorrhage or to direct damage to heart muscle, respiratory organs or nerves of both.

Surgical Shock is more likely to occur in:

  • Prolonged operations - at least longer than 30min
  • Trauma to - nerve centres, trunks or areas with rich nerve supply, brain, pleura, peritoneum or splanchnic area due to exposure to air. This leads to rapid dilation, congestion and a drop in blood pressure.
  • Cold air - as it irritates exposed tissues more than warm air, causing drying, decrease in local then general temperature leading to decreased blood pressure.
  • Poor physical condition, poor health, fitness or nutrition, too old or young.
  • Haemorrhage especially of large veins as venous return to heart suddenly drops off.
  • Chloroform more than ether.
  • Acapnia - deficiency of carbon dioxide in the blood. This is because CO2 levels regulate respiration, thus hyperventilation due to pain or over ventilation lead to shock.

In surgical shock the vasomotors are first overexcited leading to disordered action. Traube-hering waves become ordered over a wide area and become exaggerated. Later vasomotors are exhausted and finally paralysed in maximum dilation.

Blood accumulates in dilated vessels especially in the capacious splanchnic vessels. Non-return of blood to the heart causes collapse due to haemorrhage to the veins.

Vasomotors control calibre but also the activity of the vessels.

Arterial activity fills veins, venous activity maintains vena cava pressure. In shock both activities fail so venous return is further compromised. Pressure on the abdomen may help.


Hydrotherapy produces "prompt, tangible results" with "uniformly gratifying success".

Immediately on going into shock do above plus:

  • lower head of table to counter cerebral anaemia

For vasomotor failure:

In abdominal surgery apply warm gauze napkins and pressure to splanchnic area.

All this promptly increases blood pressure and increases CO2 levels in blood.

Repeat only if necessary and then only after 30min.