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Article |

The Illness of Trauma.

John Moncrief, MD
Arch Intern Med. 1973;132(1):143-144. doi:10.1001/archinte.1973.03650070129040.
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This small text, written by an orthopedic surgeon and a pathologist who have apparent extensive clinical experience, sets forth the interesting thesis that the complex clinical situation frequently seen following severe trauma (called by the author "the illness of trauma") is due to fat embolism primarily. While they concede that pump failure and pure hypovolemic shock does exist, they believe 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 that 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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