Some indications for use of the pneumatic counter-pressure devices are as follows: 1. Systolic blood pressure less than 80 mm Hg
2. Systolic blood pressure less than 100 mm Hg and the patient exhibits the classic signs of shock
3. Fracture of the pelvis or lower extremities. The only absolute contraindication in their use is pulmonary edema, although conditional contraindications include congestive heart failure, heart attack, stroke, pregnancy, abdominal evisceration, massive bleeding into the thoracic cavity, and penetrating wounds where the object is still impaled in the victim.
Application of the anti-shock garment is a relatively simple procedure but requires some important preliminary steps. When the garment is laid out flat, ensure that there are no wrinkles. If clothing is to remain on the patient, remove all sharp and bulky objects from the patient’s pockets. Take vital signs before applying the garment. The garments are inflated only sufficiently to bring the patient’s systolic blood pressure to 100 mm Hg and maintain it there. Once the garment is inflated, take vital signs every 5 minutes. The garment is removed only under the direct supervision of a physician, There is no indication for the pre-hospital removal of anti-shock garments.
Other shock treatment procedures to use are as follows:
1. Maintain an open airway. Oxygen may also be administered if proper equipment is available.
2. Control hemorrhage.
3. Check for other injuries that may have been sustained. Remove the victim from the presence of identifiable causative agents.
4. Place the victim in a supine position, with the feet slightly higher than the head (shock position). Certain problems, such as breathing difficulties or head injuries, may require other positioning.
5. Reduce pain by splinting fractures, providing emotional support, and attending to the victim’s comfort. Unless contraindicated, aspirin may be dispensed.
6. Conserve body heat.
7. Avoid rough handling and transport the victim to a medical treatment facility.
8. If transportation to a definitive care facility will be lengthy or delayed, seek the radio or phone advice of a medical officer on whether or not to give fluids by mouth or to start an intravenous line. If this is impossible, use your own judgment. Cardiogenic shock is the only exception to this rule. DO NOT start intravenous fluids since volume is sufficient and only function is impaired.
9. Constantly monitor and record vital signs every 15 minutes so that you are able to keep track of the victim’s progress.
As a corpsman in the field or on board ship in wartime, you may be issued morphine for the control of shock through relief of severe pain. You will be issued this controlled drug under very strict accountability procedures. Possession of this drug is a medical responsibility that must not be taken lightly.
Morphine is the most effective of all painrelieving drugs. It is most commonly available in syrettes or tubex in premeasured doses. Properly administered in selected patients, it will relieve distressing pain and assist in the prevention of shock. The adult dose of morphine is 8 to 16 mg repeated, if necessary, in not less than 4 hours. Morphine has several undesirable effects, however, and these must be thoroughly understood by the corpsman.
1. Morphine is a severe respiratory depressant and therefore must not be given to patients in moderate or severe shock or to patients in respiratory distress.
2. Morphine increases intracranial pressure and may induce vomiting; these effects may be disastrous in head injury cases.
3. Morphine causes constriction of the pupils (pinpoint pupils); this effect prevents the use of the pupillary reactions for diagnosis in head injuries.
4. Morphine is cardiotoxic and a peripheral vasodilator. It may cause profound hypotension in small doses in the patient in shock.
5. Morphine poisoning is an ever-present danger. There is a narrow safety margin between the amounts of morphine that may