Failing this, the introduction of saline solution at a temperature of about 105° F. into a vein or into the subcutaneous tissue is useful where much blood has been lost ([p. 276]). Two or three pints may be injected into a vein, or smaller quantities under the skin.
Thirst is best met by giving small quantities of warm water by the mouth, or by the introduction of saline solution into the rectum. Ice only relieves thirst for a short time, and as it is liable to induce flatulence should be avoided, especially in abdominal cases. Dryness of the tongue may be relieved by swabbing the mouth with a mixture of glycerine and lemon juice.
If severe pain calls for the use of morphin, 1/120th grain of atropin should be added, or heroin alone may be given in doses of 1/24th to 1/12th grain.
Collapse is a clinical condition which comes on more insidiously than shock, and which does not attain its maximum degree of severity for several hours. It is met with in the course of severe illnesses, especially such as are associated with the loss of large quantities of fluid from the body—for example, by severe diarrhœa, notably in Asiatic cholera; by persistent vomiting; or by profuse sweating, as in some cases of heat-stroke. Severe degrees of collapse follow sudden and profuse loss of blood.
Collapse often follows upon shock—for example, in intestinal perforations, or after abdominal operations complicated by peritonitis, especially if there is vomiting, as in cases of obstruction high up in the intestine. The symptoms of collapse are aggravated if toxin absorption is superadded to the loss of fluid.
The clinical features of this condition are practically the same as those of shock; and it is treated on the same lines.
Fat Embolism.—After various injuries and operations, but especially such as implicate the marrow of long bones—for example, comminuted fractures, osteotomies, resections of joints, or the forcible correction of deformities—fluid fat may enter the circulation in variable quantity. In the vast majority of cases no ill effects follow, but when the quantity is large or when the absorption is long continued certain symptoms ensue, either immediately, or more frequently not for two or three days. These are mostly referable to the lungs and brain.
In the lung the fat collects in the minute blood vessels and produces venous congestion and œdema, and sometimes pneumonia. Dyspnœa, with cyanosis, a persistent cough and frothy or blood-stained sputum, a feeble pulse and low temperature, are the chief symptoms.
When the fat lodges in the capillaries of the brain, the pulse becomes small, rapid, and irregular, delirium followed by coma ensues, and the condition is usually rapidly fatal.
Fat is usually to be detected in the urine, even in mild cases.