SÉANCE DU 19 OCTOBRE 853 



vasation of blood and lymph into the injured tissues. The measured 

 amount is insufficient. 



Application of the Foregoing 

 Considérations to the Treatment of Shock. 



1. Every effort should be made to check loss of body beat from the 

 shocked man and to restore to normal a lowered body température. 

 Avoid exposing the body; use hot drinks, bot water bottles, blankets 

 and hot air. 



2. Raise as soon as possible an arterial pressure which persists below 

 the critical level, in order to avoid the damage from oxygen want. 



3. Use preferably transfusion of blood to raise pressure; for thus, in 

 addition, oxygen carriers are added to the circulation. In the absence 

 of blood, use Bayliss's gum-salt solution, which raises pressure^ (by 

 increasing volume) and thereby causes more rapid circulation and betler 

 employment of the corpuscles as oxygen carriers. 



4. Use a tourniquet lo separate a shattered, useless part from the rest 

 of the body. Apply it near as possible to the injured région, ampu- 

 tate proximalto the tourniquet and before removing it. If a tourniquet, 

 used to stop bleeding, is to be left in place for a long period, apply it at 

 the most dtstal effective location. The surgeon must be guided in his 

 décision to save or sacrifice the part by questions of viability and gross 

 infection in the excluded région and danger to the rest of the body from 

 its rétention. 



5. If ether is used in operating on a shocked man, begin to raise his 

 blood pressure by transfusion or infusion as soon as the ansesthetic is 

 started and continue the process during the opération. Use preferably 

 nitrous oxide and oxygen, in a ratio not exceeding 3 : 1, preceded by 

 morphia. Avoid always deep anseslhesia and cyanosis. 



(The Béthune observations were published in reports to the Subcom- 

 mittee on Shock of the English Médical Research Committee and in the 

 Journal of the American Médical dissociation, February 23rd and March 

 2nd, 1918. The Dijon experiments bave not been published in détail.) 



