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Shock.Symptoms.- After receiving a severe injury, the patient becomes cold, faint, perhaps semi-unconscious ; the limbs tremble, and are unable to support the weight of the body. The pulse is very weak and rapid, and can sometimes be scarcely felt at all. The skin is cool, and often-covered with clammy perspiration ; nausea and vomiting occur. The patient's mind may remain quite clear, though more frequently he is bewildered and unable to answer questions coherently. This condition of shock is more frequently observed after severe bodily injury, but may also be induced by excessive mental emotion, especially fright. The general symptoms are essentially the same in both cases, showing that the condition results from a depression of the nervous system. Many interesting experiments upon animals illustrate the mechanism of shock in the human subject. Thus we may expose the heart of a frog and observe that it continues to beat regularly and quietly. If, however, a leg of the frog be crushed with a hammer, the motion of the heart is arrested at once. Shock may follow an injury of trifling extent, if the wound be inflicted upon a vital part of the body. In nervous and timid individuals a comparatively slight injury, which does not affect any organs of vital importance, may also be followed by the ordinary symptoms of shock. Thus, an officer was observed to fall from his horse during a battle in the late civil war. Examination showed that a bullet had pierced his breast, and he showed all the symptoms of severe shock. Upon opening his clothes to dress the wound, the surgeon was surprised to find that the bullet had been stopped by a memorandum book in the breast pocket of the ccat, and had not reached the skin. The result of shock depends largely upon its severity, as well as upon the condition of the patient at the time of the injury. The danger lies in the weakened action of the heart. If this depressing effect exceed a certain point, the heart's action ceases entirely. In some cases the patient dies within a few minutes after the receipt of the injury. In other instances he rallies for a time, but sinks again in the course of a few hours. In the latter case he may have regained temporarily full possession of his mental faculties, and the heart may have resumed its contraction with a fair degree of force. If the patient sink a second time the face becomes pale, the skin cold and clammy, as before ; the mental functions are more disturbed than they were immediately after receiving the injury. In most instances the patient dies during this second collapse. Treatment.-The prime object of treatment is to strengthen the beating of the heart. If the shock be caused by a bodily injury, the strength of the heart's action can be increased by the use of two remedies - ammonia and alcohol. The ammonia maybe given by permitting the patient to inhale it; the hartshorn should be held near to the nostrils, and the patient should be told to take long breaths. If the hartshorn be fresh and strong, it should not be approached closer than four or five inches to the nose ; or it may be diluted and held still closer. Alcohol should be given in the shape of whisky, brandy or wine ; a tablespoonful of one of these liquors may be administered in water or milk every twenty minutes until the pulse becomes stronger and the patient shows some sign of reviving. If vomiting occur, the whisky or brandy should be mixed with an equal bulk of milk and injected into the rectum. In severe cases the stimulating effect of these remedies can be most rapidly obtained by injecting whisky or ether under the skin with a hypodermic syringe. The heart can also be strengthened by the application of warmth to the body. The patient should, therefore, be warmly covered, and hot bottles or flat-irons wrapped in flannel, so as not to burn the skin, should be applied to the feet, between the thighs, to the sides, and in the armpits. The hands and arms may be rubbed briskly for the same purpose. In desperate cases extraordinary measures are sometimes required to tide the patient over the first half hour or hour of depression. Some of these measures are easily understood and applied. It is a general principle that the heart is stimulated to contraction by the presence of blood within it; this can be readily shown by removing the heart from a dog, for instance, and laying it upon the table, where it will continue to beat for a number of minutes, but finally become quiet. If we now inject some warm blood into the cavity of the heart, the organ begins to beat again with renewed vigor. This principle can be applied in various ways to stimulate the failing part of a patient suffering from a shock. One of these ways is the injection of warm blood into the vessels of the patient-an operation known as transfusion. This operation has been exten sively practiced, but because of its delicacy and of the dangers incident to it, it can be undertaken only by a medical man. To perform it, fresh blood is drawn from a bystander or from an animal, and briskly whipped with a bunch of clean straws until all the stringy part - the fibrine-has been separated from the rest of the blood and adheres to the straw. The part of the blood which remains liquid is then introduced into the arm of the patient. The effect is often most remarkable; the pulse, which may have been so weak that it could not be felt at the wrist, becomes quite strong and full; consciousness returns, the face acquires a little color, and the patient rallies markedly from his former condition. The good effects of the transfusion are apt to be transient, however; within three or four hours the individual may relapse into his former condition and require further stimulation. The dangers which accompany the introduction of blood into an individual have led to the employment of various other liquids as substitutes. Prominent among these are milk and a solution of salt in warm water. A detailed discussion of these measures is unnecessary in a work of this sort, since the operation is one of the most difficult and delicate in surgery, and should, of course, never be undertaken by a non-professional person. There are, however, several ways for securing a stimulation of the heart through an increase in the quantity of blood. While the introduction of blood from another person into the heart of the patient is both difficult and dangerous, it is a very simple procedure to introduce the patient's own blood from other parts of his body into his heart. In other words, we can transfuse the patient with his own blood. To accomplish this we have simply to force the blood from other parts of the body to the heart, and to prevent it from returning again. This plan can be carried into execution by elevating the legs of the patient, or by wrapping them firmly in an elastic bandage. In many cases the heart's action is much strengthened by simply raising the patient's legs from the bed, and by supporting them in this position for fifteen or twenty minutes. This should always be done whenever the patient's condition is such as to threaten imminent death. The quantity of blood sent to the heart can be increased by enveloping the legs in elastic bandages. The bandage should be applied while the leg is elevated, being wrapped first around the toes and then extended up the leg to the middle of the thigh. This may be allowed to remain for half an hour, at the expiration of which time the other limb may be bandaged in the same way, the bandage being removed from the first. It is not desirable that the bandage be allowed to remain upon one limb more than thirty or forty minutes at a time, since the nutrition of the part may suffer if the blood be kept out of the limb for so long a time, and portions of the skin or muscles in the leg may mortify after the bandage is removed. This measure, taken in connection with the use of stimulants and the frictions of the surface which have been already described, may often succeed in keeping the patient alive during the few hours which succeed the infliction of the injury. It should be remembered that the use of stimulants during shock can be carried to excess. In this case the patient will be apt to suffer from fever and delirium after he rallies from the injury. It is therefore necessary to discontinue the alcohol when the signs of returning strength become apparent. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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