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Hysterical Sequelae of Injuries

1944; BMJ; Volume: 1; Issue: 4343 Linguagem: Inglês

10.1136/bmj.1.4343.450

0959-8138

Peter Scott, P. Mallinson,

Automotive and Human Injury Biomechanics

MEBRITISH MEDICAL JOURNAL 2. If this does not bring about cessation of convulsive move- ments within a few minutes, intravenous sodium pentothal in 2.5% or 5%, solution (or hexobarbitone or sodium amytal) should be administered in addition to the inhalation therapy described above, and in a dosage adequate to control the convulsion.3. As soon as the convulsion is brought under control an intravenous infusion of glucose-saline (10% glucose in normal saline) should be started for the puirpose of promoting renal function and restoring the normal kidney mechanism of H-ion adjustment (that is, the elimination of excessive basic phosphates and bicarbonates via the urine).One litre of glucose-saline might well be given to an adult and 500 to 750 c.cm. to a child.Once the convulsion is under control the anaesth6tic and opera- tion may be continued, with the early termination of the latter always in mind.4. If facilities are available the patient's blood pH and/or the pH of the urine should be checked within an hour after the convulsion ceases, and CO2 and 02 inhalations should be given to the point of hyperpnoea or for 5 minutes every half-hour until such time as the blood pH is below 7.5 or an acid urine is being secreted.The reaction of the urine is not as accurate an indication of alkalaemia as the blood pH.5. Before the patient is returned to bed 2 to 3 dr. of ammo- nium chloride in six times that volume of water should be instilled by gastric tube into the stomach.6.As soon as the patient is able to swallQw he should be given cool drinks freely, but in small quantities at one time.The basis of the drinks should be physiological saline.Prior to this, rectal saline is indicated.7. The patient must be kept cool-if possible, in an air- conditioned room; or, failing that, an electric fan may be played on face and torso.8. If his temperature remains higher than 102°F.and the atmosphere is warm and possibly humid, a wet sheet may be placed on the patient's thorax and abdomen and a stream of air directed thereon from an electric fan.9.If his temperature is persistently higher than 102°F.and respiration continues to be rapid, cold 500 glucose-saline enemata may be administered in addition to the measures mentioned above.10.Inhalations of 5% CO2 and 95% 02 must be instituted on the first sign of any facial or other twitching. Summary and ConclusionsConvulsions occurring during the administration of general or local anaesthetic drugs are primarily due to interference with or inhibition of cerebral cell respiration.The interference or inhibition is usually caused by (i) frank anoxaemia; (ii) occult tissue anoxia due to alkalaemia and acapnia; or, as when local anaesthetic drugs are used, by (iii) the toxic action of the drugs inhibiting the oxidation-reduction enzymes of the tissues.The principal treatment is prophylactic.Emergency treatment is outlined.