Volume 1
Surgery : its principles and practice / by various authors ; edited by William Williams Keen.
- Date:
- 1907-1913
Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Credit: Surgery : its principles and practice / by various authors ; edited by William Williams Keen. Source: Wellcome Collection.
987/1036 (page 943)
![important. The preference for this method of infusion would rest largely upon individual cases and upon the nature of the operation. It un- doubtedly has an important place, as at the close of an abdominal operation attended by profound shock; when no contraindications exist, a considerable quantity of saline infusion may be administered. Rectal Infusion of Saline Enemata.—In many instances this method has been largely practised, and it has the advantage of being readily done without inflicting pain. Murphy has recently called attention to the very gi’adual introduction of saline infusion into the rectum through a small catheter, the pressure being so slight as to produce a flow as slowly as the rectum absorbs it. In this manner large quantities of fluid are taken up. Hypodermoclysis or Subcutaneous Infusion.—This method is much in vogue and seems to produce satisfactory results. Unfortunately it is painful, and one must be cautious in the asepsis and not introduce too large quantities in a given area, causing a prolonged anemia of the parts, which might terminate in sloughing. Infusion by several needles under the breasts, in the loose tissue over the pectoral muscle, in the back or thighs accompanied by gentle massage, is an effective method. This may be repeated from hour to hour or day to day as the case may require. This is especially indicated when there is not sufficient urgency to demand an immediate intravenous infusion, and when the other method of rectal infusion is not admissible or when the rectum is too irritable. Physiologic Rest.—Not the least factor in the treatment of shock is the securing of physiologic rest. This, however, is oftentimes most diffi- cult to attain and its best accomplishment taxes the utmost resources of the surgeon and nurse. Physiologic rest implies the calming of fears, the subduing of excitement, and the instillation of hope; it implies the relief of the important higher centers from pathologic impulses. To accomplish this, anxious and terrified friends must be controlled, the patient’s surroundings must be quiet, the management precise and simple, and the surgeon in attendance must exclude from his manner every evidence of anxiety. Summary.—(a) Shock.—Physiologic rest is the most important con- sideration in the treatment of shock. The patient should bo kept men- tally and physically at rest. Surgeons and nurses should bring assurance and confidence. The patient should be made comfortable. If this cannot be satisfactorily accomplished by management and nursing, then give a minimum of anodynes. It is not well to tax the patient with unimpor- tant annoying routine measures. The foot of the bod should be elevated. In more critical cases the extremities and the abdomen may be snugly bandaged. Saline solution per rectum, subcutaneously or intravenously, according to the urgency, may be given. If the foregoing seems unavailing, 15 minims of adrenalin chlorid (1:1000) may be added to 500 c.c. saline solution administered subcuta- neously, and in extreme urgency a continuous infusion of 1 : 20,000 adrenalin solution at the rate of 2 c.c. ])er minute should bo tried. (5) Collapse.—In colla])so from reflex inhibition, such as may attend](https://iiif.wellcomecollection.org/image/b2811968x_0001_0987.jp2/full/800%2C/0/default.jpg)
