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May 1, 1897


JAMA. 1897;XXVIII(18):851. doi:10.1001/jama.1897.02440180037008

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From a consideration of the relation between high altitude and surgical shock Wetherill (Annals of Surgery, April, 1897, p. 430) recommends in the performance of surgical operations, and under conditions of surgical shock generally, the patient should be spared the loss of every drop of blood possible. The importance of this precaution increases greatly as higher elevations are reached and the atmospheric pressure is correspondingly diminished. Anemic and exsanguinated patients are more susceptible to surgical shock at high altitudes than at sea-levels, and must be more carefully prepared for operations; extra precautions against shock must be observed both at the operation and afterward. Increasing shock after injuries or operations must be construed as strong presumptive evidence of continuing hemorrhage. It must be made clear that there is no hemorrhage before the ordinary remedies (cardiac stimulants, transfusion, etc.) are employed. The reflex effect of oozing is to cause a continuation of

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