The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
These experiments also suggested the so-called “_pneumatic suit_”
devised by Dr. Crile, which is in effect a double-layered garment
of rubber cloth. The patient is enveloped in the suit, which can be
inflated with an ordinary bicycle pump, so that pressure is made upon
the surface of the body, and at the same time evenly distributed.
By such pressure accumulation of blood in the venous reservoirs is
prevented, and the emptying of the arteries, especially those in the
brain, is prevented. This is a more perfect and ideal application of
the idea underlying the practice of _bandaging the extremities_ or
raising them, in extreme conditions of shock; the former requires an
elaborate and expensive outfit, while for the latter purpose cotton
bandages or rubber may suffice. The latter, however, must be used with
great caution lest pressure be overdone. When the bandages are removed
they should be taken off slowly, and from one limb at a time, lest the
change be too abrupt.
Two other expedients are of the greatest value in conditions of
this kind; the first is _artificial respiration_. This cannot be
carried out, as is done on experimental animals, in a well-furnished
laboratory, by opening the trachea and making connection with a pump;
it must be effected by the usual methods, coupled with the aid afforded
by the improved Fell apparatus. If oxygen can be administered at the
same time it will enhance the effect.
The second expedient is _rhythmic pressure_ made over the lower part
of the thorax, or beneath the ribs, by which is produced a stimulus to
contraction of the heart. This may be made slowly at first, but may
approximate a rate corresponding to a slow pulse.
The temptation is to use the adrenalin solution too strong or in too
large doses. It may be administered in doses of 4 or 5 minims in a
small syringeful of salt solution, but when the symptoms are profound
and the case urgent, 300 to 500 Cc. of sterilized salt solution,
containing the same amount, should be injected beneath the skin into
the subcutaneous cellular tissue about the shoulder-blade, the buttock,
behind the breast, or into a convenient vein. Much larger amounts, even
up to 1000 Cc., may be used, but the adrenalin should never be mixed
until just before using it, as it is quickly oxidized and changed, and
should be used in the freshest possible condition. With salt solution
containing 1 to 50,000 of adrenalin and continuously administered,
Crile has kept a decapitated dog alive for over ten hours--that is,
the heart continued its action. One may agree with him, then, in the
statement that “_control of blood pressure is the control of life
itself_.”
Public-domain text, read in full here on John Shaqi.
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