SEPTICEMIA FOLLOWING WOUND INFECTION
Symptoms.—After operations performed under the most thorough aseptic or antiseptic procedure, wound fever, more or less marked, may be expected. It develops a few hours after operation and subsides in twenty-four or forty-eight hours. If, however, the wound has not been properly rendered aseptic, or in which there is reason for irritation or tension, more serious symptoms may develop about the second or third day. These symptoms increase with the amount of infection in the wound and result in septicemia, or septic intoxication, the outcome of the absorption of ptomains—the product of tissue decomposition.
Inflammatory fever is marked by a sudden rise in temperature, 100° to 103° F., with a full, strong, and rapid pulse, headache, anorexia, coated tongue, constipation and diminished secretion. If the infection is severe delirium comes on.
If the symptoms are not relieved promptly the indications of septicemia assert themselves with an increasing temperature, between 102° and 104° F., with a rapid compressible pulse gradually becoming weaker. The respirations are rapid and shallow. The tongue becomes dry and discolored and the teeth are covered with sordes.
The restlessness disappears and apathy, somnolence, and a low type of delirium takes its place. Vomiting occurs. There may be a profuse diarrhea and the urine is passed involuntarily. In other words, septicemia is but an aggravated continuance of inflammatory fever; untoward symptoms may come on early, and death may result within forty-eight hours.
On inspection, the infected wound appears highly inflamed, there is increasing swelling, with more or less pain in the part. The edges of the wound appear pale and everted. Serous oozing comes from the wound. If sloughing is to occur from tension or low vitality of the parts the area becomes discolored, assuming at first a pale green color, which turns into bluish brown—and, lastly, brown.
Treatment.—The treatment of such wounds is to immediately relieve all tension by withdrawing the sutures. Flush the wound with peroxid solution and irrigate thoroughly with a 1-3,000 bichlorid solution, leaving the wound open for a free drainage.
Then apply iodoform gauze over the wound and change the dressings as often as is deemed necessary—two or three times a day. In severe cases open the wound thoroughly, even by further incision, clean out the contents of the wound, such as foreign matter, bloodclots, exudate, or perhaps pieces of bone that may have been overlooked, using a small, sharp spoon curette for the purpose. See that the deeper recesses of the wound, especially in those about the nasal bones, are thoroughly gone over.
Next irrigate the wound with a 1-1,000 bichlorid solution. Carbolic solutions to be of use in the severer cases, are too irritating and cause an increase of the secretions, hence they are not to be used. Furthermore, their toxic property is not desirable and ofttimes are not well borne by the patient.
The wound is now loosely filled (not packed) with iodoform gauze to permit of perfect drainage. Aseptic absorbent cotton may be placed over this.