This report is made for the purpose of emphasizing the value of methods recently adopted in combating surgical shock. The circumstances which usually attend a crush of such a character as to necessitate double amputation usually entail active and prolonged hemorrhage. As a rule such patient must be transported a considerable distance, often many miles, before skilled attention can be secured. Preliminary efforts at hemostasis are made hastily and in most primitive fashion, by persons untrained and often unbalanced by the exigency. Improvised tourniquets are so adjusted as to admit of their being displaced downward, whereby their efficiency becomes totally annulled; and curiously enough, a second attempt in the same direction is rarely made. Accordingly, as a rule, the surgeon is confronted by a patient who is pulseless, or nearly so, cold, and in a profound state of collapse. To defer amputation until resort may be had to reactionary measures,
HUNTINGTON TW. DOUBLE SYNCHRONOUS AMPUTATION. THREE CASES ON LOWER EXTREMITIES. JAMA. 1899;XXXIII(2):76. doi:10.1001/jama.1899.92450540018002e
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