Pressure sore

“ An acute inflammatory irritation is established, setting up a vicious circle. For the pressure causes nerve irritation, and the nerves retaliate by still further disturbing the circulation, thereby causing more pressure. ”

“ Pressor effects, i.e. those causing increased constriction and rise of arterial pressure, may be produced by stimulating the central end of almost any afferent nerve, and especially that of a cutaneous nerve. Depressor effects are always obtained by stimulating the depressor nerve, and may be obtained by stimulating the afferent nerves under special conditions. That these reflex vaso-motor effects frequently occur is shown by the blush of shame, the blanching of the face by fear, the blanching of the skin by exposure to cold and the flushing which is produced by heat. ”

“ If, as Sir Lauder Brunton tells us, "the irritation of sensory nerves tends to cause contraction of blood- vessels AND TO RAISE THE BLOOD-PRESSURE"; if, as Straus affirms, "PAIN INCREASES BLOOD-PRESSURE," so that in a healthy person the pressure is increased even by pinching of the skin; if, as the physiologist Dalton declares, the irritation of any of the sensitive nerves induces a constriction of bloodvessels indicated by icreased arterial pressure ”

“ Vide Pereira's Materia Medica, vol. i. pp. 101, 106.
[23] Such is the case in health, when the muscular pressure of the intestine must exceed the pressure on the vascular system on the other side. This latter pressure, when increased, tends to stop or to reverse the inward current. Thus plethora and fever, diseased conditions, counteract absorption by causing pressure on the coats of these capillary vessels. ”

“ Excess of pressure produces an aching pain; and the cramp, caused by repeated electrical stimulation of the muscles, is at once appreciated.
Pressure, which ordinarily causes a sensation of touch or of pain, produces no effect upon consciousness when applied to a fold of skin elevated into a ridge, thus proving that the sensations which are present are not due to any end-organs remaining in the skin. ”

“ Any active, hustling man, or a man under strain, has a rise of blood pressure during that strain, especially notable with surgeons during operation, or with brokers or persons under high nervous tension. ”

“ When the blood is in a thick or viscous condition the use of the hot water adds to its fluidity, and it can then be forced more easily through the capillaries, thus greatly lessening the blood pressure. ”

“ Often the increase of tension is no more than their [417] age would account for, and equally often no symptoms indicative of raised blood pressure are complained of. Why then make the subject miserable? ”

“ People now suspect the condition, and they frequently seek their physicians to determine if the blood pressure is too high and, from reading health journals, more or less realize some of the things, at least, that must be done to decrease the pressure. ”

“ However, profuse purging in heart disease may be followed by unfavorable symptoms, especially when the systolic blood pressure is low. When there is hypotension, or when the diastolic pressure is high and the venous pressure is high, and when there is edema or effusion, watery catharsis should be caused only after due consideration, and always with a careful watching of the effect on the heart and blood pressure. The blood pressure is lowered by such catharsis, and the heart is often slowed. ”

“ Suddenly, or after a precedent feeling of pressure, there is severe griping pain in the pit of the stomach, usually extending into the back, with a feeling of faintness, shrunken countenance, cold hands and feet, and small, intermittent pulse. The pain becomes so excessive that the patient cries out. ”

“ When the artery is rolled under the finger, then it may seem that there is some thickening in its walls, though it is only heightened blood pressure from emotion that causes the feeling. This high blood pressure may, of course, of itself be an indication of danger whenever there is heart or kidney disease, but it often occurs as a passing event in nervous patients whose vasomotor control is so capricious that arterial tension and blood pressure may change at very short intervals as the result of excitement. ”

“ If one takes the highest pressure at the strongest beat, which may be only one in a dozen or more, that may be true, but that does not represent the action of the much embarrassed heart. We know that the circulation is much interfered with, that there is hypostatic congestion, that the mass action is slow. The pulse pressure is greatly disturbed and the head of pressure which should force the blood to the periphery is so little that the circulation almost ceases. ”

“ The principal bad effect produced by the air pressure appears to be that of severe pains in the joint8 and muscles of the arms and legs. As these have been, in most cases, traced to hard work and consequent copious perspiration, and also to too long a stay under pressure, it has been suggested as a probable cause that small globules of air make their way through the skin, or between the skins, where they remain, and on the workman returning to ordinary atmospheric pressure, expand, and thereby cause the most agonising pains in the joints, the elbows, shoulders, knee-caps, and other places. ”

“ Heredity, the wear and tear of modern life, the use of alcohol, tobacco and coffee may produce exceptional blood pressures. Development of high blood pressure is a process rather than a disease; the symptoms develop rather late in its course ”

“ Some chronic diseases cause a slow pulse; this is especially true of chronic interstitial nephritis. In fact, it may be stated that any disease or condition which increases the blood pressure generally slows the pulse, unless the heart itself is affected. This is true of hypertension, of arteriosclerosis, of nicotin unless the heart has become injured, and often of caffein, unless it acts in the individual as a nervous stimulant. Chronic lead poisoning causes a slow pulse on account of the increased blood pressure. ”

“ Such persons as a rule are not long-lived, inasmuch as their power of resistance is small, owing to their lack of blood, a lack in quality as well as in quantity. The blood pressure in their arteries and veins is light, as evidenced by their pale, sallow complexion, and the dry, scaly, feverish skin, which seldom or never perspires. ”

“ Thus, although an increase of work is thrown on the upper part of the lungs, breathing cannot be naturally performed, and from this many serious diseases may arise. A tendency to consumption is hereby encouraged, and, even without this tendency, blood-spitting may be caused by the pressure. But, besides interfering with the action of the lungs, this pressure, in limiting the space occupied by the other organs, hinders their natural and healthy motions, the heart and stomach are deranged, the action of the liver hampered, the movements of the bowels restricted. ”

“ So that we find that (1) where the solid organs are, the greatest pressure comes; (2) where the hollow viscera lie, little pressure comes; (3) on organs that are comparatively fixed in their places, much stress is brought to bear; and (4) on organs freely movable, like the intestines, less direct displacing force is exerted.
Effect of Pressure on the Abdominal Wall.—Long-continued compression of the wall of the abdomen in the epigastric and hypochondriac regions gradually brings about a thinning of its adipose layer.* Below the ring of constriction the fat accumulates. ”

“ Again, in cases in which the climacteric troubles, dependent in part on increased general arterial blood-pressure, manifest themselves chiefly in the form of active congestions, fugitive heats, vertigo, etc., the employment of hot baths is likely to be most useful by leading to a notable enlargement of the cutaneous capillary bloodvessels and consequent lowering of arterial blood-pressure. ”

“ If the heart is made rapid, and the heart muscle shows signs of weakness, the duration of these baths must not be long, and they may be contraindicated. These baths are most efficient in lowering the blood pressure when the patient reclines for several hours after the bath. The amount of sweating that is advisable in these cases depends on the condition of the heart. If the heart muscle is insufficient, profuse sweating is inadvisable. Also if the kidneys are insufficient, profuse sweating is inadvisable as tending to concentrate the toxins in the blood. ”

“ Over-dilatation both of the heart and lungs being thus prevented, the blood expressed from the abdomen is driven through the lungs into the left ventricle, and so into the arteries. So long as the general and intense muscular spasms continue, there is increased resistance to the outflow of the blood through the capillaries both of the abdominal viscera and the limbs. The arterial pressure rises, therefore, and the flow of blood to the central nervous system is increased. ”

“ If there is much exudate, the pressure on the heart of course increases, the cardiac dulness enlarges, dyspnea occurs and even perhaps later cyanosis. As the exudate accumulates, the patient must lie higher and higher in order that the fluid may gravitate to the lowest part of the sac and give the heart the greatest ability to work. Reflex pain may occur from disturbances of the pneumogastric nerve, or from the weight and pressure of the enlarged and heavy pericardium. Reflex vomiting may be a troublesome and distressing symptom. ”

“ High pressure is due to a large quantity of blood being in the arteries, and this may be due either to the rapidity with which it is injected by the heart or to the reduced capacity of the bloodvessels themselves. High pressure, due to the latter cause, throws a great strain upon the heart, owing to the hard work it has in pumping blood into the arteries; with a low pressure the heart beats feebly, having less resistance to overcome. ”

“ The blood pressure is low and, as a result of this disturbance of the circulation, faintness is a common early symptom. Extreme pallor is often noticed. The secretions are increased, and the sweat and the saliva may be secreted in abnormal quantities. ”

“ When the body is turned [pg 894] on the face, gentle but efficient pressure should be made along the back, between the shoulder blades, to assist in forcing the air out of the lungs, but this pressure ought to be removed before the patient is turned back on his side. Persistently repeat this operation, and success will often be the reward. As soon as respiration is established, warmth may be promoted by the application of warm flannels to the body and bottles of hot water to the stomach, armpits, thighs, and feet. ”

“ In some experiments to determine the changes upon the blood pressure induced by hot and cold applications on and within the abdomen, Hammett, Tice and Larson found that heat applied to the outside of the abdomen raises the blood pressure. The application of cold produces no change. Either hot or cold saline introduced within the abdomen causes a fall in blood pressure. ”

“ The majority of fibers from the left vagus are distributed to the A-V node so that its most evident action is upon the conductivity of the impulse. Pressure then on the right vagus will have a tendency to slow the whole heart. Pressure on the left vagus will have a tendency to prolong the P-R interval until even complete block occurs. Even when the heart block is complete, stimulation of the accelerator nerve, as a rule, increases the rate of both auricles and ventricles. ”

“ Press gently upon the abdomen, press especially upon the epigastrium, often even in these very cases not the slightest touch can be borne. After pressure has once been made, the patient will frequently do all he can with his hand to prevent its being made a second time. So acutely sensible is he of pain on the least pressure, though wholly unconscious of pain when left to himself. Even when there is not this great degree of tenderness, pain can generally be produced by full pressure. ”

“ As a result of splanchnic stimulation there was an average recovery of 42 per cent in the nerve-muscle and of 46 per cent in the muscle. The increased general blood pressure was effective, therefore, quite apart from any possible action of adrenal secretion, in largely restoring to the fatigued structures their normal irritability.
The Effect of Decreasing Arterial Pressure
Inasmuch as an increase in arterial pressure produces an increase in the height of contraction of fatigued muscle, it is readily supposable that a decrease in the pressure would have the opposite effect. ”

“ COUNTER-CONDITIONING
When you are exposed to a situation that you believe is threatening, your blood pressure and pulse rate go up, your muscle tension increases, the blood supply to your large muscle groups increases, circulation to your stomach and genitals is {176} reduced, your pupils may dilate, your mouth may get dry. ”

“ The heart's action grows feebler, often slower, the pulse weaker; blood-pressure sinks and arterial tension is diminished. Its physiological action is that of a direct stimulant to the heart and the pneumogastric nerve; its toxic action, that of a depressant. Upon the vaso-motor system the action is from the first that of a depressant. Dilatation of capillary vessels and increased afflux of blood manifest themselves in the flushed face, brilliant eyes, and warmth of surface which are familiar phenomena. Frequent repetition tends to permanently impair the activity of the peripheral circulation. ”

“ This produces a change in blood pressure within the brain, and the 'sinking' sensation in the chest, or the dizziness of the head of a person moving rapidly, or it may even result in unconsciousness, and complete suspension of respiration, effects which sometimes follow rapid movements, as in a person falling from a considerable height. ”