Ralph Adams

Surgical care of complicated gastric and duodenal ulcer in small hospitals.

THIS report is concerned with the surgical care of gastric and duodenal ulcers in two small hospitals in New Hampshire. It covers a period of two and a half years, ending June 30, 1953, during whic...

RESPONSIBILITIES AND METHODS IN MAINTENANCE OF HOMEOSTASIS IN UNCONSCIOUS PATIENT

Shock, syncope, coma, and general anesthesia are characterized by the abeyance of various reflexes, some of which are essential for survival. The inadequacy of the patients responses to conditions that handicap respiration may be especially important. To prevent catastrophes during and after anesthesia the patients relaxed muscles need assistance, particularly those concerned directly or indirectly with breathing; his position must be such that his airways can be kept free from blood and vomitus, and it may be necessary to remove obstructing material from pharynx or trachea by aspiration. Some patients should have periods of a few minutes at a time in prone or lateral positions lying head down for postural drainage; others who have had operations on the neck may need to be nursed sitting up. Restlessness is not always caused by pain; when it results from hypoxia, the use of narcotics is dangerous because it further depresses the protective reflexes. If prompt and effective treatment is to be available to every patient in emergency, planning is necessary. The equipment must really be at hand, for it is the seconds and not the minutes that count. The requirements include (1) an emergency endotracheal set, (2) an efficient suction apparatus, and (3) apparatus capable of administering oxygen under positive pressure.