236. Suspended Animation Hanging, Drowning, etc.
DROWNING is the most common cause of suspended animation, though cases of hanging and of suffocation from noxious gases occasionally occur.
SYMPTOMS- There is no breathing or action of the heart perceptible; the eyelids are generally half-closed; the pupils dilated; the jaws clenched; the fingers semi-contracted; the tongue appearing between the teeth, and the mouth and nostrils are covered with a frothy mucus. Coldness and pallor of surface increase.
TREATMENT- Not a moment’s time should be lost. The patient should be attended to immediately, on the spot, while remedial aids are being fetched. All mere spectators and useless helpers should be sent away, as the admission of abundance of pure air to the patient is of first importance. When a drowned man is taken from the water, he should be first turned on his face to allow the escape of water from his mouth and throat. Artificial respiration should then be attempted.
The directions for restoring the apparently dead, recommended by that noble organization, the Royal Humane Society, are so concise and complete, that we cannot do better than reproduce them, with a few alterations.
The points to be aimed at are first and immediately, the RESTORATION OF BREATHING; and secondly, after breathing is restored, the PROMOTION OF WARMTH AND circulation.
Figure I. INSPIRATION.
Figure II. EXPIRATION.
To illustrate the position of the body during the employment of the Method of inducing Respiration.
TREATMENT TO RESTORE NATURAL BREATHING.
To maintain a Free Entrance of Air into the Windpipe. Cleanse the mouth and nostrils from dirt, saliva, etc. open the mouth; draw forward the patient’s tongue, and keep it forward; an elastic band over the tongue and under the chin will answer this purpose. This drawing forward of the tongue is very important, as it opens the windpipe, and must therefore never be omitted. Remove all tight clothing from about the neck and chest.
To adjust the Patient’s Posture- Place the patient on his back on a flat surface, inclined a little from the feet upwards; raise and support the head and shoulders on a small firm cushion or folded article of dress placed under the shoulder blades.
To Imitate the Movements of Breathing- (See engravings.) The operator, standing or kneeling behind and at the head of the patient, should grasp the patient’s arm just above the elbows, and draw the arms gently and steadily upwards, till they meet above the head (this is for the purpose of inspiration, or drawing air into the lungs), and keep the arms in that position for two seconds. He should then turn down the patient’s arms, and press them gently and firmly for two seconds against the sides of the chest (this is with the object of pressing air out of the lungs, expiration).
If an assistant compress with both hands, flat, the lower parts of the ribs and diaphragm, when the patient’s arms are turned down, the expiration will be facilitated. The operator and assistant must carefully act together.
As the process of artificial respiration is laborious, the best qualified assistants should be selected to take turns with the operator; but changing places must be rapid, that not a single respiratory movement may be missed.
Repeat these measures alternately, deliberately, and perseveringly, fifteen times in a minute (the difficulty is to prevent the too rapid movements of over-zealous assistants), until a spontaneous effort to respire is perceived, immediately upon which cease to imitate the movements of breathing, and proceed to INDUCE CIRCULATION AND WARMTH according to Rule 5.
Should a warm bath be procurable, the body may be placed in it up to the neck, continuing to imitate the movements of breathing. Raise the body in twenty seconds in a sitting position, and dash cold water against the chest and face, and pass ammonia under the nose. The patient should not be kept in a warm bath longer than five or six minutes.
To excite inspiration- During the employment of the above method, excite the nostrils with snuff or smelling-salts, or tickle the throat with a feather. Rub the chest and face briskly, and dash cold and hot water alternately on them.
The efforts to restore life must be persevered in until the pulse and breathing have ceased for at least an hour, for well- attested instances of resuscitation are on record, after several hours of suspended animation.
Another method of effecting artificial respiration is by catheterism of the trachea. “The operator inflates from his own chest; but as he is able to drive in much more air than is absolutely necessary, its impurity is of no great consequence. An assistant must empty the patient’s lungs by compression of the thorax between the insufflations.”
TREATMENT AFTER THE RESTORATION OF NATURAL BREATHING.
Rule 5.-To induce Circulation and Warmth- Wrap the patient in dry blankets and commence rubbing the limbs upwards, firmly and energetically. The friction must be continued under the blankets or over the dry clothing.
Promote the warmth of the body by the application of hot flannels, bottles or bladders of hot water, heated bricks, etc., to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet. Warm clothing may generally be obtained from bystanders.
On the restoration of life, when the power of swallowing has returned, a teaspoonful of warm water, small quantities of warm wine, warm brandy-and-water, or coffee, should be given. In some cases, an enema of beef-tea and brandy is to be preferred to administration by the mouth. The patient should be put into a warm bed, in a room well ventilated, and encouraged to sleep. Great care is requisite to maintain the restored vital actions, and at the same time to prevent undue excitement.
In cases of Suffocation from Hanging, the treatment is much the same, after the body has been cut down, and the ligature removed from the neck.
When a Stroke of Lightning has produced Asphyxia, the body should be dashed for ten or fifteen minutes with abundance of cold water to promote reaction. The body should also be diligently rubbed. But artificial respiration should be resorted to. A current of electricity passed through the chest, from breast to back, may prove beneficial.
237. Concussion of the Brain.
DEFINITION- An interruption to the functions of the brain, from a blow or other mechanical injury of the head; it may vary in degree from a slight —— extinction of life.
SYMPTOMS- Partial or complete insensibility—— face; rapid, irregular, small or imperceptible—–slow, shallow, irregular breathing; cold —– etc. By shaking the patient, or calling his name loudly in his ears (which, however, should never be done), he may give a surely answer, and soon become insensible again. After a time, longer or shorter according to the severity of the injury, reaction comes on, and consciousness returns, with rise of temperature (101 degree to 102 degree F.), and some irritability; often there is vomiting. At first the reaction may be imperfect; it is often several days or even weeks before the power of the mind is restored.
TREATMENT- Arnica. Place two pilules upon the tongue, or moisten it with a few drops of the tincture by means of a feather or quill, and repeat the dose every hour for several times.
Aconitum- Should be administered alternately with Arnica if fever attend the return of consciousness. But if there be danger of cerebral disturbance headache, flushed face, or other head- symptoms Aconite and Belladonna should be alternated. Opi. Stertorous breathing; constipation, remaining after concussion. Hyoscyamus Delirium, low or furious. A dose every one, two, or three hours.
GENERAL TREATMENT- The patient should be placed in a warm bed, with his head at first moderately low, and warmth applied to his extremities and axillae. On no account should he be induced to eat or drink; he must also be kept very quiet, and no attempt made to arouse him. When reaction comes on, the head and shoulders should be raised a little, and cold evaporating lotions applied, keeping the patient at the same time in a cool, quiet room, with the light modified, and noise and conversation shut out. He must be under care for two or three weeks, lest some insidious inflammation should arise within the head.
238. Burns and Scalds.
DEFINITION- An injury produced by radiated heat from any hot body, or by the direct contact of hot solid, liquid, or gaseous substances.
A burn is comparable to roasting and a scald to boiling.
VARIETIES- (1) The Erythematous, producing mere redness, and soon terminating in resolution; (2) The Vesicated, in which the inflammation leads to the formation of vesicles, which, in slight cases, soon dry up and heal; or if the skin has been much injured, may be succeeded by obstinate ulcers. (3) Leading to destruction of the skin and more or less of the deeper tissues. It involves all the dangers of inflammatory fever, and septic absorption. This variety, although usually exempt from pain, is by far the most serious.