SECONDARY ILEMORRHAGE. — When secondary hemorrhage occurs from a stump, pre sure and elevation may ar rest it and should be tried before resort ing to other measures. If it cannot be stopped by these means, the wound is to be opened up again—provided the union is not far advanced and the cavity seems to be filled with clots—and the bleeding vessel caught and ligated. If, however, the wound is nearly healed and there do not seem to be many clots, the Inumor rhage is to be controlled by securing the artery, of which the bleeding vessel is a branch, just above the stump, and either applying acupressure or cutting down and ligating it. If hemorrhage still per sists, the main artery may have to be ligated in continuity or even amputa tion may hare to be performed.
When secondary hemorrhage occurs from an artery which has been tied in continuity, pressure should first be ap plied by means of graduated compresses to the bleeding-point. In some arteries near the trunk this is the only means by which one may hope to stop the haemor rhage, but in others, where bleeding still persists, the wound is to be opened, the vessel secured, and a ligature applied above and below the source of haemor rhage. When, however, the vessel can not be found or lriemorrhage recurs after ligation, the main artery must be tied, or amputation performed, especially if it is the lower extremity that is involved.
Injuries of Veins.
Injuries and wounds of veins are not, as a rule, followed by as serious results as in the case of arteries.
Hannorrhage from a vein is dark in color, and may be stopped by pressure upon the distal side of the wounded ves sel, thus distinguishing it from arterial bleeding, which cannot he thus con trolled.
from the smaller veins usually ceases of itself, while pressure on the distal side is of value in those some what larger. When the large veins are injured, however, ligatures should be ap plied. Phlebitis and gangrene very sel dom follow. When the wound is only on one side of a large vein it is often pos sible to lift the wall on either side of the wound with forceps and apply a ligature.
Entrance of Air into Veins.
Symptoms.—At the point when the air enters the vein there may often be heard a peculiar hissing or gurgling sound, and frothy bubbles appear in the wound. The patient suddenly becomes pale and is partially collapsed. The heart-beat is irregular, the pulse feeble, and respiration difficult and gasping. Death sometimes follows immediately or may be deferred a number of hours. In cases in which only a small amount of air is introduced recovery may occur.
Etiology.—Operations in the vicinity of the large veins at the root of the neck and in the axillary space are especially liable to this accident.
Treatment. — Prophylaxis consists in using the handle of the scalpel to sepa rate the fascia in operations about the large veins and in first ligating any vein that may need to be divided.
When the accident has occurred, the wound is to be immediately filled with water, the vein is to be compressed and a ligature applied as soon as possible. The head of the patient should be low ered, and mouth-to-mouth insuffiation or other methods of artificial respiration practiced. Cardiac stimulants, as digi talis or brandy, hypodermically, are in dicated, and inhalations of oxygen-gas are often of value.
Vascular Obstruction.
Thrombosis.—A thrombus is a clot of blood which forms in the heart, blood vessels, or the lymphatics during life..
Thrombosis is the process of forming such a clot.
Thrombosis may occur in the heart, the arteries, the capillaries, the veins, and in the lymphatic vessels. The coagulum, or thrombus, consists of fibrin inclosing within its meshes a larger or smaller number of blood-globules, which, in rap idly-formed thrombi, are both red and white, producing the dark color of such thrombi when first formed. In thrombi which are of glower and gradual forma tion, and in those due to projections from the interior of the vessels, the red cells may be absent and the thrombus be color less or yellowish white. The white cells are present in much larger proportion than in normal blood.