Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
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Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--A patient suffering from shock should be placed in the
recumbent position, with the foot of the bed raised to facilitate the
return circulation in the large veins, and so to increase the flow of
blood to the brain. His bed should be placed near a large fire, and the
patient himself surrounded by cotton wool and blankets and hot-bottles.
If he has lost much blood, the limbs should be wrapped in cotton wool
and firmly bandaged from below upwards, to conserve as much of the
circulating blood as possible in the trunk and head. If the shock is
moderate in degree, as soon as the patient has been put to bed, about a
pint of saline solution should be introduced into the rectum, and 10 to
15 minims of adrenalin chloride (1 in 1000) may with advantage be added
to the fluid. The injection should be repeated every two hours until the
circulation is sufficiently restored. In severe cases, especially when
associated with hæmorrhage, transfusion of whole blood from a compatible
donor, is the most efficient means (_Op. Surg._, p. 37). Cardiac
stimulants such as strychnin, digitalin, or strophanthin are
contra-indicated in shock, as they merely exhaust the already impaired
vaso-motor centre.
Artificial respiration may be useful in tiding a patient over the
critical period of shock, especially at the end of a severe operation.
Failing this, the introduction of saline solution at a temperature of
about 105° F. into a vein or into the subcutaneous tissue is useful
where much blood has been lost (p. 276). Two or three pints may be
injected into a vein, or smaller quantities under the skin.
Thirst is best met by giving small quantities of warm water by the
mouth, or by the introduction of saline solution into the rectum. Ice
only relieves thirst for a short time, and as it is liable to induce
flatulence should be avoided, especially in abdominal cases. Dryness of
the tongue may be relieved by swabbing the mouth with a mixture of
glycerine and lemon juice.
If severe pain calls for the use of morphin, 1/120th grain of atropin
should be added, or heroin alone may be given in doses of 1/24th to
1/12th grain.
#Collapse# is a clinical condition which comes on more insidiously than
shock, and which does not attain its maximum degree of severity for
several hours. It is met with in the course of severe illnesses,
especially such as are associated with the loss of large quantities of
fluid from the body--for example, by severe diarrhœa, notably in Asiatic
cholera; by persistent vomiting; or by profuse sweating, as in some
cases of heat-stroke. Severe degrees of collapse follow sudden and
profuse loss of blood.
Collapse often follows upon shock--for example, in intestinal
perforations, or after abdominal operations complicated by peritonitis,
especially if there is vomiting, as in cases of obstruction high up in
the intestine. The symptoms of collapse are aggravated if toxin
absorption is superadded to the loss of fluid.
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