2. _At the Advanced Dressing Station_, after the patient has had a
liberal allowance of warm fluid nourishment, such as soup or tea, a full
dose of anti-tetanic serum is injected. The tourniquet is removed and
the wound inspected. Urgent amputations are performed. Moribund patients
are detained lest they die _en route_.
3. _In the Field Ambulance or Casualty Clearing Station_ further
measures are employed for the relief of shock, and urgent operations are
performed, such as amputation for gangrene, tracheotomy for dyspnoea, or
laparotomy for perforated or lacerated intestine. In the majority of
cases the main object is to guard against infection; the skin is
disinfected over a wide area and surrounded with towels; damaged tissue,
especially muscle, is removed with the knife or scissors, and foreign
bodies are extracted. Torn blood vessels, and, if possible, nerves and
tendons are repaired. The wound is then partly closed, provision being
made for free drainage, or some special method of irrigation, such as
that of Carrel, is adopted. Sometimes the wound is treated with bismuth,
iodoform, and paraffin paste (B.I.P.P.) and sutured.
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