Læknablaðið - 01.04.1943, Blaðsíða 15

L ÆKNABLAÐIÐ
it must be expected. Tertiary
shock, is rarely seen in ordinary
times. However, this is seen in
increasing numbers in war time,
where the large numbers of casuals
have strained the efficency and
promptness 'of treatment. It may be
considered as a prolongation of
secondary shbck, due to further
loss of plasnta. Here the blood con-
centration Ijecomes so great that
spontaneous thrombosis and ent-
bolus formation,with death, occurs.
This stage has an extremely grave
prognosis, and every effort to pre-
vent its occurence should be made.
Normal viscosity of l)lood which
is 2.4, is increased to 6 or 7 in this
type of shock.
I should now like to outline what
I believe- is a satisfactory method
of treatment of burns. I am greatly
indebted to a recent article by Fox,
whose ideas largely coincide with
mine. The outline is similar as to
treatment tb the one suggested by
him, with the addition of special
consideration for the care of the
hands, face and genitals. The entire
treatment can be divided into two
parts, emergency and hospital
treatment. And these two steps are
further divided into general and
local treatment. Again let us stress
the importance of the treatment 'Oí
shock, for no matter what the local
treatment is, it is our successful
treatment 'of shock which largely
determines whether we save the
liíe of the patient or not.
Emergency treatment.
First. — Treatment of shock.
This is done by keeping the patient
as warni as possible, the use 'of
stimulants, the use of morphine
liberally and the use of plasma.
Morphine, in the adult, should be
given generously in grain doses,
and repeated as necessary to alle-
119
viate pain. This cuts down on the
incidence of shock. Liberal use of
morphine is mandatory, and timi-
dity in its use is inexcusable. It
is alntost impossible to kill this
type of patient by the liberal use
of morphine. Next, the liberal use
of plasma is also mandatory. We
must be liberal and use enough.
It is not the loss of erythrocytes
that we have to worry about, buí
the loss of plasma, with the result-
ing hemoconcentratibn. The
amount to be used in emergencv
treatment would depend only on
the severity of the case, and the
cjuick availabilty of the hospital.
It is therefore necessary that at
first aid stations, adequate plasma
be on hand, for it is here that the
battle for the patient’s life may be
won or lost. Next as a stimulant,
adrenal oortical hormone shoulcl be
used in 2 cc doses and repeated as
needed, and the use of oxygen
through a suitable mask is recom-
mended if available.
Local emergency treatment. I am
going to recommend the use of the
triple dye instead of the sulfodia-
zene, triethanolamine for various
reasons. It is easier to ])rocure, is
far cheaper, and is almost as effic-
ient. It may be procured in a water
soluble jelly base and easily applied
for first local treatment. Further-
more, and I believe this is impor-
tant, eschar f'ormation takes place
within 8 hours while with the sul-
fodiazene-triethanolamine, it requ-
ires four days. Where personnel is
taxed by large numbers of cases,
this becomes increasingly inqtor-
tant.
Ambulatory cases, ancl these
should not include burns of the
hands, face or genitals, can be kept
at the first aicl station until the
eschar fdom the triple dye forms.