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and below displaced widely with a rib spreader or a Balfour abdominal retractor, which answers the same purjjose. At this point I make a practice of tying all bleeding points and removing all forceps. The parietal pleura is grasped with stomach for- ceps and the knife cautery at red heat is applied in a line about three inches in length and enlarged if necessary to admit of free access to the under- lying structures. This incision in most instances should conform to the direction of the ribs. Four stomach forceps are applied to this parietal incision, and it is retracted well above and below, and stitched to the visceral pleura with single O continuous cat- gut on a full curved fine needle. The knife cautery at red heat is applied to the visceral layer, the length corresponding to the parietal incision. The anesthetic is removed as the lung is approached and the cautery is used as one would use a scalpel in penetrating the lung tissue. With this method hemorrhage is practically absent except in the division of the larger blood vessels, and for the sake of safety these should be tied. The foreign body having been removed, or the abscess drained, as the case may be, the line of incision is permitted to collapse after the insertion paxil discount of a fanshaped drain of rubber tissue or a small cigarette drain, loosely covered and without gauze projecting from the end. If the wound edges are not apposed at the completion of the operation, one kidney suture of fine catgut may be used on a heated needle. The wound in the pleura may be partially closed over the drainage and a buttonhole paxil price without insurance incision made through the skin. The rib retractor is removed and the fractured rib replaced, or re- moved entirely, in the pus cases. The skin is closed with interrupted silk or silkworm gut and adhesive tape tightly applied, the wound is cheap purchase online paxil dressed and a pneumonia jacket applied. LUNG COLLAPSE \\'hen gas-oxygen is used with a paxil buy rebreathing ap- I)aratus the lung does not' collapse in a large per- centage of cases, and in others only partially so, the entire operation being performed with only a slight change in respiration. The postoperative morbidity is decreased materially if we paxil price india can circumvent lung collapse and the tedious convalescence of delayed reexpansion is obviated purchase paxil to a great extent. Postoperative posture. — Posture is important in that it favors paxil 10 mg drainage and prevents in a great measure paxil mg the respiratory embarrassment so common in chest surgery. The paxil 12.5 mg patient usually paxil 30 mg rests better in the semiFowler position, lying on the affected side. If the incision inclines posteriorly air bags or pillows should be placed to insure rest. Postoperative attention is paxil price in pakistan of great importance and the smoothness of convalescence will be in direct proportion to the paxil price care the patient receives. Morphine and atropine hypodermically in full paxil cr doses repeated vmtil respirations are decreased to eight or ten a minute rx paxil the first twenty-four hours, is, in mv opinion, good treatrnent. A wool pneumonia jacket should be applied in every case and I believe it decreases the incidence of bronchitis or lobular pneumonia, so frequent in these cases and so serious when they occur. Postoperative delirium. — This may be very vio- lent in character and necessitate constant watching, or it may manifest itself as a low muttering speech and restlessness. I am of the opinion that the toxic element with its attendant fever is first in the pro- duction of delirium and secondly cardiac decom- pensation manifesting itself as a tachycardia, ar- rhythmia, or cyanosis, and due possibly to dilatation of the purchase cheap paxil right heart. Cool sponging, the hot wet pack, normal salt solution with sodium bicarbonate intra- venously, or blood transfusion may be required. Cyanosis. — Slight cyanosis always is present to some ■ extent, owing to the sudden changes in the pulmonary circulation and the attempt on the part of the heart to maintain circulatory equilibrium. Cyanosis in favorable cases usually disappears in forty-eight to seventy-two hours, but I have seen instances of its persisting paxil prescription for days, and this with a healed wound, regular heart, and low temperature. cheap order paxil Strychnine and belladonna are useful in this con- dition, in that they sustain the patient and tend paxil 25 mg to equalize circulation. Temperature. — Postoperative temperature is some- times quite high for the first twenty-four to seventy- two hours, and inay require a warm pack, glucose solution intravenously, or blood transfusion the second or third day following, if the temperature rises again, usually will control temperature in the favorable cases. generic paxil Delayed rcc.vpausion. — This condition should be treated by breathing exercises, the two bottle siphon method, and an abundance of fresh air. •■

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