Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
The _clinical features_ of this condition are practically the same as
those of shock; and it is treated on the same lines.
FAT EMBOLISM.--After various injuries and operations, but
especially such as implicate the marrow of long bones--for example,
comminuted fractures, osteotomies, resections of joints, or the forcible
correction of deformities--fluid fat may enter the circulation in
variable quantity. In the vast majority of cases no ill effects follow,
but when the quantity is large or when the absorption is long continued
certain symptoms ensue, either immediately, or more frequently not for
two or three days. These are mostly referable to the lungs and brain.
In the lung the fat collects in the minute blood vessels and produces
venous congestion and œdema, and sometimes pneumonia. Dyspnœa, with
cyanosis, a persistent cough and frothy or blood-stained sputum, a
feeble pulse and low temperature, are the chief symptoms.
When the fat lodges in the capillaries of the brain, the pulse becomes
small, rapid, and irregular, delirium followed by coma ensues, and the
condition is usually rapidly fatal.
Fat is usually to be detected in the urine, even in mild cases.
The _treatment_ consists in tiding the patient over the acute stage of
his illness, until the fat is eliminated from the blood vessels.
TRAUMATIC ASPHYXIA OR TRAUMATIC CYANOSIS.--This term has been
applied to a condition which results when the thorax is so forcibly
compressed that respiration is mechanically arrested for several
minutes. It has occurred from being crushed in a struggling crowd, or
under a fall of masonry, and in machinery accidents. When the patient is
released, the face and the neck as low down as the level of the
clavicles present an intense coloration, varying from deep purple to
blue-black. The affected area is sharply defined, and on close
inspection the appearance is found to be due to the presence of
countless minute reddish-blue or black spots, with small areas or
streaks of normal skin between them. The punctate nature of the
coloration is best recognised towards the periphery of the affected
area--at the junction of the brow with the hairy scalp, and where the
dark patch meets the normal skin of the chest (Beach and Cobb). Pressure
over the skin does not cause the colour to disappear as in ordinary
cyanosis. It has been shown by Wright of Boston, that the coloration is
due to stasis from mechanical over-distension of the veins and
capillaries; actual extravasation into the tissues is exceptional. The
sharply defined distribution of the coloration is attributed to the
absence of functionating valves in the veins of the head and neck, so
that when the increased intra-thoracic pressure is transmitted to these
veins they become engorged. Under the conjunctivæ there are
extravasations of bright red blood; and sublingual hæmatoma has been
observed (Beatson).
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