upon. In almost all cases, first aid treatment is a calm, professional understanding demeanor without aggravating or agitating the patient. With the assaultive or hostile patient, a “show of force” may be all that is required. Almost all cases of psychiatric emergencies will present with a third party, either the family or friend of the patient, who has recognized a distinct change in the behavior pattern of the patient and who is seeking help for them.
DERMATOLOGIC EMERGENCIES
Most dermatologic cases that present as emergencies are not really emergencies. The patient perceives them as such because of the sudden presentation and/or repulsive appearance or excessive discomfort. Most dermatologic conditions are treated symptomatically. The major exception to this is toxic epidermal necrolysis (TEN).
Toxic epidermal necrolysis is a condition of sudden onset characterized by excessive skin irritation, painful erythema, bullae, and exfoliation of the skin in sheets. It is also known as the scalded skin syndrome because of its appearance. It is thought to be caused by a staphylococcal infection in children and a toxic reaction to medications in adults.
Since skin is the largest single organ of the body and serves as a barrier to infection, prevention of secondary infection is of utmost concern. Treatment consists of isolation techniques, silver nitrate compresses, aggressive skin care, intravenous antibiotic therapy (Nafcillin or Methicillin) and, in drug induced cases, systemic steroids.
EMERGENCY CHILDBIRTH
Every corpsman must be prepared to handle the unexpected arrival of a new life into the world. If the corpsman is fortunate, a prepackaged sterile delivery pack will be available. This will contain all the equipment needed to deliver a normal baby. If the pack is not available, imaginative improvisation of clean alternatives will be needed.
When the corpsman is faced with an imminent childbirth, the first determination to be made is whether there will be time to transport the expectant mother to a hospital. To help make this determination, the corpsman should try to find out whether or not this will be the woman’s first delivery (first deliveries usually take much longer than subsequent deliveries); how far apart the contractions are (if less than 3 minutes, delivery is approaching); whether or not a mother senses that she has to move her bowels (if so then the baby’s head is well advanced down the birth canal); whether or not there is crowning (bulging) of the orifice (crowning indicates that the baby is ready to present itself); and how long it will take to get to the hospital. The corpsman must weigh the answers to these questions to decide if it will be safe to transport the patient to the hospital.
Prior to childbirth a corpsman must quickly “set the stage” to aid the event. The mother must not be allowed to go to the bathroom since the straining may precipitate the delivery in the worst possible location. Do not try to inhibit the natural process of childbirth by having the mother cross her legs. The mother should be lying back on a sturdy table, bed, or stretcher. A folded sheet or blanket should be placed under her buttocks for absorption and comfort. Remove all clothing below the waist, bend the knees and move the thighs apart, and drape the woman with clean towels or sheets. The corpsman should then don sterile gloves or, if these are not available, rewash his or her hands.
In a normal delivery, your calm professional manner and sincere reassurance to the mother will go a long way towards alleviating her anxiety and making the delivery easier for everyone. Help the woman rest and relax as much as possible between contraction. During contraction, deep, open mouth breathing will relieve some pain and straining. As the child’s head reaches the area of the rectum, its pressure will cause the mother to feel an urgent need to defecate. Reassurance that this is a natural feeling and a sign that the baby will soon be born will alleviate her apprehension.
Watch for the presentation of the top of the head. Once it appears, take up your station at the foot of the bed and gently push against the head to keep it from popping out in a rush. Allow it to come out slowly. As more of the head appears, check to be sure that the umbilical cord is not wrapped around the neck. If it is, gently try to untangle it, or move one section over the baby’s shoulder. If this is impossible, clamp in two places, 2 inches apart, and cut it. Once the chin emerges, use the bulb syringe from the pack to suction the nostrils and mouth while you support the head with one hand. Compress the bulb prior to placing it in the mouth or nose; otherwise, there will be a forceful aspiration into the lungs. The baby will now start a natural rotation to the left or right, away from the face down position. As this is occurring, keep the head in a natural relationship with the back. The shoulders appear next,