Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
(_a_) Arterial hemorrhage may be recognized by rapid, spurting jets of
red blood, occurring synchronous with the heart beat.
(_b_) Venous bleeding (from a vein) occurs as a steady even stream of
dark blood, not affected by the heart beat.
(_c_) Capillary hemorrhage is in the form of a steady stream oozing
from the raw surface of a tissue. The color is intermediary, as both
arterial and venous capillaries contribute to it.
+Nature’s Efforts to Control Hemorrhage.+ When an artery is severed,
the inner and middle coats immediately retract and curl up within the
lumen, partially closing up the cut end.
Blood has the property of clotting, if it comes in contact with
anything but the natural endothelial lining of the vessels.
The curling in of the inner and middle coats retards the escaping
stream and facilitates coagulation within the cut end of the vessel
now formed by the outer coat alone. When the hemorrhage is severe,
these processes are reinforced by an increased tendency to coagulate,
and by a weakened heart action.
+The Control of Hemorrhage.+ The object of treatment in every case is to
check the flow of blood, and, though death from ordinary wounds is
rare, yet the loss of much blood is weakening for a long time.
The principle on which we act in our efforts to permanently stop
bleeding, depends on the power which the blood has of clotting, or as
it is called, coagulating.
If by any means the blood can be made to “stand still” in a blood
vessel at the point of injury, it will clot, thus forming a plug which
prevents further escape.
In wounds involving only small veins or capillaries from which there
is no distinct jet of blood (capillary hemorrhage), pressure of the
thumb, a wad of sterile gauze intervening, will usually suffice in a
few minutes. Gauze dipped in hot water applied to such wounds, also at
times effects a stoppage of such bleeding. Often only tight bandaging
is necessary.
Bleeding from large arteries or veins can be controlled temporarily by
pressure directly over the wound.
Temporary control may also be obtained by digital pressure above or
below the wound, if in a leg or arm, depending upon whether the escape
is chiefly from a vein or an artery, for in any wound some of the
bleeding will be capillary. This method, or the application of a
tourniquet, will absolutely control bleeding in an extremity.
The pressure in arterial hemorrhage must be applied at a point nearer
the heart and in venous hemorrhage at a point away from the heart.
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