Surgery.

Date:: [1913]

Credit: Surgery. Source: Wellcome Collection.

34/412 page 26

$shock, which comes on insidiously some hours after the injury, is not known. It is known that certain factors pre- dispose to it, e.g. exposure, fluid loss, fatigue and pain, and although the signs of shock are like those of haemorrhage the two conditions are quite distinct although they may both be present at the same time. Theories of its causation are : (1) excessive stimulation of nerve endings ; (2) failure of the adrenal glands ; (3) absorption of toxic substances from the wounded area. Whatever the cause the fact remains that there is a fall in the circulating blood volume either from loss of blood, loss of fluid into the injured 'part, or by the damming up of blood in the dilated capillaries. The fall in blood volume means a decrease in the heart’s output and deficient circulation, so that suboxidation of the tissues results. The capillary walls will suffer damage if the blood pressure remains 'low, and fluid escapes into the tissues, thus still further reducing the blood volume. The symptoms and signs are pale, sweaty skin, with slight cyanosis, subnormal temperature, increased pulse rate, and a fall in blood pressure. What is the Treatment ? The onset of shock may be prevented or its severity lessened by relieving the pain of the injury, e.g. splinting a fracture ; by warmth and by the giving of fluids such as water, warm sweet tea ; and by the rapid control of bleed- ing- i , The patient is placed in a warm bed under a shock cage, and the foot of the bed is elevated. Morphine j gr. is given, and bleeding is controlled. If able to swallow, fluids are allowed, and half a teaspoonful of salt is given with each pint to make good the chloride loss. If swallowing is im- possible fluid may be given per rectum or by intravenous drip. The most important treatment is the administration of blood (in cases of haemorrhage), dried plasma or serum (where bleeding has not occurred), and in bad cases 3-4 pints may be required. No operation should be considered until the blood pressure has become normal.$

Surgery.

Licence and re-use

Contents