Chicago.
In a recent article (1) I called attention to the
importance of the knife cautery procedure as an
operative technic in decreasing postoperative shock,
hemorrhage, and the morbidity incidental to con-
valescence. It can be used in incising the visceral
pleura and the lung proper, in removing foreign
bodies, such as bullets, fragments of high explosive
shells, and particles of bone or bits of clothing,
carried into the lung tissue by the missile, and in
operating for hemorrhage, lung abscess, or tumor.
Before the advent of the knife cautery, pulmonary
operations were the least developed and the least Generic Norvasc Price
understood from the viewpoint of technic and post-
operative complications of all forms of surgery.
The mortality rate Norvasc Other Names was exceedingly high, shock
and hemorrhage being the chief contributors, and
the postoperative morbidity continued over a period
of weeks or months.
Hemorrhage. — Heretofore hemorrhage has been Buy Norvasc 5mg
very Norvasc 50 Mg difficult to control and postoperative Norvasc Canada oozing
has caused a large number of deaths, owing to the
facts that suture of lung tissue is unsatisfactory in
the control of bleeding and the needle punctures
themselves continue to bleed after the wound is
closed. Lung tissue in particular must be free
from oozing when the wound is closed, or the bleed-
ing- may continue for an indefinite period, exsan-
guinating the patient and being almost impossible
to control without a large firm packing. The re-
moval of this packing produces a return of bleeding,
and, Norvasc Coupon while it is in position, it causes incessant Norvasc Cmi cough-
ing, which so greatly weakens Generic Norvasc 10mg an already over-
burdened heart that cardiac dilatation is likely to
occur. Furthermore, iodoform or cyanide gauze Norvasc Coupons
will in almost every case cause some symptoms of
toxemia, the absorption being so rapid that often
within twenty-four hours toxic symptoms manifest
themselves by rigor, vomiting, high temperature, and
delirium.
Shock. — Profound shock followed by delirium
accompanies a large percentage of pulmonary
operations by the older Norvasc 100 Mg methods, induced, I believe,
by the combined factors of hemorrhage, anesthesia,
and packing. Then, too, the class of patients in
whom these operations are indicated suffer from
low vitality, secondary anemia, and usually present
profound toxic phenomena. Blood transfusion is,
in my opinion, the ideal treatment in this condition.
Lung abscess, tumors and foreign bodies are in-
dications for surgical intervention, and with all of
these dyspnea and cardiac weakness or irregularity
are prominently associated. Obviously, therefore,
any procedure which decreases the danger of post-
operative shock Norvasc 5mg Generic or cardiac dilatation is to be pre-
ferred.
Dyspnea. — All cases of pulmonary disease re-
quiring surgical operation are accompanied by dysp-
nea, its severity depending upon the location of the
diseased area, the toxic element, and cardiac com-
pensation. Pleural effusions and hemothorax greatly
embarrass respiration, and I believe it is good prac-
tice to aspirate or drain these accumulations forty-
eight hours before pneumotomy is to be performed.
Atropin and digitalis in full doses sometimes Norvasc 7.5 Mg will
temporarily control dyspnea to a Norvasc Pi great extent. When
it is dependent upon increased intrathoracic pres-
sure it is impossible to control until this pressure is
relieved. Postoperatively, strychnine, administered
in large doses hypodermically, diminishes respira-
tion and may sustain the circulation through the
shock period. Morphine of course is preeminent
in Cheap Norvasc Online decreasing respiration and quieting delirium, as
well as controlling cough.
TECHNIC
Location of incision — external marking.- — The
location of the primary incision on the chest wall
should conform to the pulmonary area to be incised
as nearly as possible. Preliminary outlining with
•Read before the Chicago Academy of Medicine, May 27, 1920.
674
I'AX PAING: SURGERY OF THE THORAX.
iodine or silver nitrate .stick is useful in that it
remains as a guide after sterilization of the chest
wall is complete. The incision may be U shaped
or longitudinal, Norvasc Logo conforming to the contour of the
ribs, the primary flap consisting of skin, superficial
and deep fascia down to the muscle. The muscles
may be separated or incised. The number of ribs
chosen is important, three being Norvasc 7 Mg the usual number. Norvasc 5mg Price
All of them may be fractured, and reflected; or Norvasc 2 Mg Norvasc Patent one
may be fractured and removed and the one above
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