Surgery, with Special Reference to Podiatry — John Shaqi
Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
should be aspirated and pressure applied before structural changes
take place, such as the formation of a membrane. If the latter occurs
and sufficient time has elapsed for the formation of definite new
tissue, aspiration may be followed by the obliteration of the sac.
Sometimes hematomata become so thoroughly and firmly organized and
gradually increase in size, that it is extremely difficult to
differentiate them from new growths. If pain and tenderness persist
for a long time, particularly, if there be a predisposition to
tuberculosis, especial care is necessary.
+Treatment of Wounds in General.+ Arrest hemorrhage, bring about
reaction, remove foreign bodies, asepticize, drain, coaptate the edges
and dress, secure rest to the part and combat inflammation.
Constitutionally, allay pain, secure sleep, keep up the nutrition and
treat inflammatory conditions.
+Arrest of Hemorrhage.+ To arrest hemorrhage the bleeding point must be
controlled by digital pressure until ready to be grasped with forceps;
it is then caught up and tied with catgut or aseptic silk. Slight
hemorrhage stops spontaneously on exposure to air, and moderate
hemorrhage ceases after the vessels are clamped for a time; an
injured vessel of some size must be ligated, even if it has ceased to
bleed.
Capillary bleeding is checked by hot water compresses. In bringing
about reaction from shock, raise the feet and lower the head, unless
this position causes cyanosis. At least place the head flat and the
body recumbent. Apply hot water bottles and hot blankets and give
hypodermic injections of ether, brandy, strychnine, digitalis or
atropin, or inhalations of amyl nitrate. Strychnine can be used in
large doses, one-thirtieth of a grain may be given every ten or
fifteen minutes, until three doses have been taken. If the skin is
very moist, atropin is indicated, alone or combined with strychnine.
Hot coffee, or other hot fluids, should be given by the mouth and
rectum, and mustard should be placed over the heart, spine and shins.
The use of hot and stimulating rectal enemata is very important. The
rectum may absorb when the stomach refuses to do so. Enemata of hot
normal saline solution are very beneficial.
+Enteroclysis.+ The tube is carried into the sigmoid flexure and the
injection is introduced so as to distend the colon. At times it may be
necessary to give an intravenous injection of saline solution in order
to overcome the shock. In order to prevent the suppression of urine,
it may be necessary to administer diuretics.
+Removal of Foreign Bodies.+ Remove with forceps, all foreign bodies
visible to the eye: splinters, bits of glass, portions of clothing,
dirt, etc.
In a lacerated or contused wound, portions of tissue injured beyond
repair should be regarded as foreign bodies and should be removed with
scissors.
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