Illustrating forced flexion for control of hemorrhage.
The first measure, then, in the treatment of a wound is to prevent loss of blood. This may be done in various ways, and the method should depend upon the circumstances of the case. In emergency cases it may be accomplished either by direct pressure, by constriction of the limb above the injury, or in some instances by mere position. If it be possible to make direct pressure through the medium of some clean—preferably sterile—dressing or material, this of course would be desirable. In all civilized armies soldiers are now equipped with a package of sterile dressing by which an emergency pad for this purpose can be promptly applied. Railroads and steamers are now providing emergency outfits. In injury of the arm or leg advantage may be taken of position, i. e., forced flexion, which is maintained by any measure or material which can be made available for this purpose ([Fig. 60]). Digital compression over a main vessel may also serve a good purpose. Mere elevation of the part, as, for example, the head, when not otherwise contra-indicated, or a hand or foot, will do much to check venous or arterial flow. Moreover, in these positions reflex contraction of arteries occurs, even in those of the head when the arms are elevated. For this reason in cases of serious nose-bleed it is often advisable to keep the arms raised high above the head.
Of other means resorted to may be mentioned:
1. Extremes of Heat and Cold.
—Water at a temperature of 130° to 160° F. is a powerful hemostatic. It stimulates contraction of the muscular coats of the vessels and produces coagulation of the albuminous portions of the blood upon the surface to which it is applied, and in this way plugs the capillaries and small arteries and so prevents oozing. Heat with pressure will be serviceable in many instances. Cold may be employed by means of ice or iced water and may be made serviceable in cavities like the mouth, the vagina, or the rectum, after patients have recovered from the anesthetic and at a time when hot water could not be borne. Cold has more of a constringing effect but less coagulating property.
2. Pressure Directly Applied.
—This may be made with a tampon in some cavity, or by a graduated absorbent dressing whose effect may be regulated by pressure of a bandage or an elastic bandage. Care should be always given that pressure be not too long nor too firmly made, and it should be released as soon as there appears edema of the part below or any evidence of insufficient circulation.
3. Styptics and Chemical Agents.
—There are many substances which contract vessels and cause more or less coagulation of blood, and at one time there were many of these in general use, but they have been supplemented by other products, i. e., cocaine, antipyrine, and adrenalin. The effect of cocaine is temporary, but sometimes is sufficient in the urethra or the nasal cavity. Antipyrine, in 5 to 10 per cent. solution, alone or with cocaine, has a similar effect, but is more lasting. Some years ago the writer stated that by mixing 10 per cent. solutions of antipyrine and tannin there was precipitated a gum-like material of extraordinary tenacity. This will check oozing from any part to which it may be applied, but it may adhere so tightly as to make it difficult to later remove the tampon. Of the hemostatic drugs, adrenalin has the most marvellous properties. It can be procured in solutions of 1 to 1000. A solution of this strength, somewhat diluted, may be spread or applied upon an oozing surface with almost instantaneous effect.