Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood PressureOsborne, Oliver T. (Oliver Thomas)
Science
Disturbances of the Heart: Discussion of the Treatment of the Heart in Its Various Disorders, With a Chapter on Blood Pressure
Osborne, Oliver T. (Oliver Thomas)
Blood pressure; Heart -- Diseases
The most satisfactory action, especially from the epinephrin, is
from small doses frequently repeated. Sometimes in serious
emergencies it has been found to be of value when given
intravenously in physiologic saline solution. The close, of course,
should be very small. In circulatory weakness in acute illness,
epinephrin has been given regularly, a few drops (perhaps the most
frequent dose is 5) of a 1: 1,000 solution, on the tongue, once in
six hours. Such a dosage may be of value, and certainly is better
than the administration of too much strychnin. Much larger or more
frequent doses are likely, as just stated, to depress the
respiration.
Besides the small amount of blood pressure-raising substance
secreted by the hypophysis cerebri. it has not been shown that any
other gland of the body furnishes vasopressor substance except the
suprarenals.
Atropin: When there is great cardiac weakness, atropin may be used
to advantage. The dose is from 1/200 to 1/150 grain hypodermically,
not repeated in many hours. It will whip up a flagging heart, more
or less increase the blood pressure, cause cerebral awakening, and
may often be of value. If there is any idiosyncrasy against atropin,
if the throat and mouth are made intensely dry, or if there is
serious flushing or cerebral excitement, the dose should not be
repeated.
Morphin: This would rarely be considered as an emergency drug in
cardiac weakness. A small dose of it, not more than one-eighth
grain, especially if combined with atropin, will often quiet and
brace a weak heart, especially when there is cardiac pain. Just
which drug or drugs should be used and just which are not indicated
can never be specifically outlined in a textbook, a lecture or a
paper. The decision can be made only at the bedside, and then
mistakes, many times unavoidable, are often made.
In all conditions of shock with cardiac failure, the blood vessels
of the abdomen and splauclinic system are dilated, and more or less
of the blood of the body is lost in these large veins, and the
peripheral and cerebral blood pressure fails. The advantage in such
a condition of firm abdominal bandages, and of raising the foot of
the bed or of raising the feet and legs, need only be mentioned to
be understood.
It is a pretty good working rule, in cardiac failure, not to do too
much. On the other hand, life is frequently saved by proper
treatment, and the physician repeatedly saves life as surely as does
the surgeon with his knife.
CONVALESCENCE
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