TRAUMATIC AND SEPTIC SHOCK ALIAS POSTTRAUMA CRITICAL ILLNESS

Background The mortality associated with septic shock, both in percent age of septic shock cases and total number of septic shock cases, has been increasing over the past several decades. This is despite major a dvances in diagnosis and treatment. The basic cause of traumatic and s eptic shock has been only partially elucidated. Methods Data sources i nclude research papers on the subject of traumatic and septic shock fr om 1875 to the present. These papers numbered over 10 000,few of which are included in the reference list because many are duplicative or ne gative. Over 1000 articles were reviewed which documented the unsucces sful search for a treatment for septic shock based on the theory that septic shock is due to endotoxin and its secondarily induced host medi ators. These references are available from the author. Results and con clusion The concept of a shock toxin in trauma and sepsis as promulgat ed during World War I is correct. This toxin is a thrombogenic aminoph ospholipid which occurs only on the inner layer of all cell membranes and is liberated by cell destruction. It causes disseminated intravasc ular coagulation which may obstruct the microcirculation of any or all organs, producing multiple organ failure by microclots. These microcl ots may be lysed by plasminogen activator and circulation to the organ s restored.