1. Treat the underlying disease process.

2. Maintain and maximize perfusion and oxygenation.

3. Begin basic resuscitation (airway, breathing, circulation) and then proceed to more complex manipulation of the cardiovascular system and intravascular volume:

a. maintain adequate oxygenation of the lungs;

b. establish venous access;

c. rapidily infuse colloid, crystalloid, and/or blood (if hemoglobin is less than 10 g/dl);

d. use central venous pressure or pulmonary artery pressure manometry;

e. use pulse oximetry;

f. once adequate filling has been achieved, consider the use of vasoactive drugs to achieve a specific therapeutic aim. Chapter References

Boyd, O., Grounds, R.M., and Bennett, E.D. (1993). A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. Journal of the American Medical Association, 270, 2699-707.

Consensus Conference (1988). Perioperative red blood cell transfusion. Journal of the American Medical Association, 260, 2700-3.

Czer, L.S.C. and Shoemaker, W.C. (1978). Optimal hematocrit value in critically ill postoperative patients. Surgery, Gynecology and Obstetrics, 147, 363-8.

Lindner, A. (1983). Synergism of dopamine and furosemide in diuretic-resistant, oliguric acute renal failure. Nephron, 33, 121-8.

Malmberg, P.O. and Woodson, R D. (1979). Effect of anemia on oxygen transport in hemorrhagic shock. Journal of Applied Physiology, 47, 882-8.

Shoemaker, W.C., Appel, P.L., Kram, H.B., Waxman, K., and Lee, T.-S. (1988). Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest, 94,


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