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
A tourniquet may be devised from a handkerchief, a piece of rope or of
rubber tubing wound around the limb and tightened just enough to
arrest the main stream; in addition, pressure exerted over the wound
will control whatever hemorrhage persists. Such a control can only be
temporary, as the arrest of circulation in an extremity below the
tourniquet for more than an hour or two might cause gangrene. However,
there is no great fear of this occurring, as some blood reaches the
parts through deep vessels.
Permanent control of such hemorrhages can only be effected by grasping
the severed vessels in the open wound with artery clamps, and then
ligating below the clamps with cat gut.
Deep-seated hemorrhages, in the abdomen or chest, can often be
controlled by pressure directly over the wound until an open operation
can be performed.
Deep pressure, with the fist upon the abdomen just to the left of the
vertebral column, will compress the aorta and greatly reduce the
escape of blood from any artery supplied by the descending aorta.
+Hemorrhage in Chiropody.+ For the chiropodist, bleeding is an annoying
and especially perplexing occurrence. The feet are the most
bacteria-laden part of the body; here are warmth and moisture,
congenial to bacteria, and a thick epidermis for their safe
concealment. When hemorrhage occurs, therefore, its proper control
along antiseptic lines is imperative.
The vessels severed are rarely of sufficient size to cause the escape
of blood in an actual stream, but rather as a rapid oozing. It is, as
a rule, capillary hemorrhage.
The methods for its control have already been described in this
chapter, and will always stop such bleeding.
In chiropodial practice, however, the degree of bleeding determines
the method of treatment, and, though the extreme may fall short of
actual danger, it still behooves the operator to control it
absolutely before dismissing his patient.
+Easily Controlled Bleeding.+ The degree of bleeding or slight oozing,
as it should be termed, incident to skiving a calloused surface, is
well controlled with styptics.
In employing these substances it should be borne in mind that they are
not usually antiseptic but, on the contrary, may harbor organisms
which may be transferred to the wound and cause infection. The
subsulphate of iron, commonly employed in the form of Monsel’s
solution, is usually employed because of its efficiency as a styptic,
and because of the fact that it is less irritating than others. It,
however, is not antiseptic and should be kept sterile and
uncontaminated by dropping it upon the wound directly from the bottle,
rather than by dipping the cotton-wound applicator into it, as is so
frequently done. Even this does not prevent an originally sterile
bottle of solution from becoming contaminated, exposure to the air,
when the stopper is removed, admitting many bacteria each time.
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