Where cosmetic result is not a consideration, sutures may be slightly further apart. Generally, the distance of the needle bite from the wound edges should be equal to the distance between sutures.
8. When subcutaneous sutures are needed, it is proper to use 4-0 chromic catgut.
9. When deciding the type of material to use on skin, use the finest diameter that will satisfactorily hold the tissues.
a. Children under 3 yrs, face: 6-0
b. All other faces 5-0
c. Body 4-0
d. Feet, elbows, knees #34 or #36 wire or 4-0
e. Child’s scalp 4-0
f. Adult’s scalp 3-0
g. Lip 6-0 or 5-0
10. When cutting sutures, subcutaneous catgut should have a 1/16 inch tail. Silk skin sutures should be cut as short as is practical for removal on the face and lip. Elsewhere, skin sutures may have longer tails for convenience, but a tail over 1/4 inch is unnecessary and tends to collect exudate.
11. The following general rules can be used in deciding when to remove sutures:
Face: As a general rule, 4 or 5 days. Better cosmetic results are obtained by removing every other suture and any suture with redness around it on the third day and the remainder on the fifth day.
Body and scalp: 7 days.
Soles, palms, back or over joints: 10 days unless excess tissue reaction is apparent around the suture, in which case they should come out sooner. Any suture with pus or infection around it should be removed immediately, since its presence will make the infection worse.
When wire is used, it may be left in safely for 10 to 14 days.
Figure 4-51.—Symptoms of shock.
SHOCK
Shock is the collapse of the cardiovascular system, characterized by circulatory deficiency and depression of vital functions. There are several types of shock. Hypovolemic shock is due to diminished blood volume; neurogenic shock results from the loss of vascular control by the nervous system; cardiogenic shock is due to inadequate functioning of the heart; septic shock develops in the presence of severe infection; and anaphylactic shock is due to an allergic reaction. Multiple types of shock maybe present in varying degrees in the same patient. The most frequently encountered and most important type for the corpsman to understand is hemorrhagic shock, a type of hypovolemic shock.
In shock, the diminished blood volume causes a markedly lessened cardiac output and reduced peripheral circulation. This results in a lowered transport of oxygen to the tissues (hypoxia); decreased perfusion, the circulation of blood within an organ; and a lowered transport of waste products away from the tissue cells. Under these conditions, body cells are able to carry on their normal functions for only a short period of time. Soon they begin to malfunction and then shut down. Certain cells, especially in the heart, brain, liver, and kidneys, are highly susceptible to temporary or permanent damage. Permanent renal shutdown is an ever present danger in shock.
Shock should be expected in all cases of gross hemorrhage, abdominal or chest wounds, crush or blast injuries, extensive large muscle damage, particularly of the extremities, major fractures, traumatic amputations, head injuries, burns involving more than 10 percent of the body surface area, or any other major injury.
