THE METABOLISM OF TKAUMATIC SHOCK 261 



shock are thus associated, first, with maintaining the blood volume at a 

 fairly normal level, and secondly, with maintaining the body temperature 

 of the patient. In cases where hemorrhage is involved, it is important 

 that it should be stopped before transfusion is attempted. 



A tourniquet bound for some time about an injured extremity is 

 to be regarded with dread, because its removal may, and occasionally does, 

 precipitate a severe shock, due probably to the sudden release into the 

 blood stream of toxic substances. If the extremity is to be amputated, it 

 is much wiser to leave the tourniquet in place and to operate above it. 



After Care. The care of a case in shock does not end with the 

 return of the blood pressure above the critical 'level. Fluids should be 

 forced for several days or until the output nearly equals the intake 

 for blood transfusion does not usually bring the blood volume to normal 

 level. The patient's temperature must likewise be watched, and artificial 

 heat continued, if necessary. Infections in convalescence are quite com- 

 mon, and it is important to watch and guard the patient against them. 



