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The Illness of Trauma.

John Muncrief, MD
Arch Intern Med. 1973;131(2):311. doi:10.1001/archinte.1973.00320080147037.
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This small text written by an orthopedic surgeon and a pathologist, both with extensive clinical experience, sets forth the thesis that the complex clinical situation frequently seen following severe trauma and called by the authors "The Illness of Trauma" is due primarily to fat embolism.

While they concede that pump failure and pure hypovolemic shock does exist, the authors state that "traumatic shock" is a more complex variant in which increased capillary permeability secondary to hypoxia results in fluid loss and sludging. The supposedly physiologic explanations for the changes which occur, the clinical signs and symptomatology, and therapy based on this thinking is difficult to follow in many instances. For example, the authors state that as capillary permeability increases and fluid is lost from the vascular compartment, hydrostatic pressure increases relative to osmotic pressure and blood elements and protein are forced through the capillary walls.

The authors attempt to develop


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