SYMPTOMS—By far the most common complaint is sudden onset of dyspnea. Pleuritic pain is common in moderate to severe embolisms. Hemoptysis, rales, pallor, foul breath, increased respirations, and shock may or may not result. In some cases of pulmonary embolism, a lung infarction with resulting abscess formation may occur.
TREATMENT—Oxygen therapy in high concentration (preferably 100 percent) is essential to overcome anoxia. Administer meperidine for pain, treat for shock, and hospitalize as soon as possible.
Decompression Sickness
An acute illness in which nitrogen bubbles are forced into the bloodstream. It sometimes occurs in persons flying at high altitudes and following rapid reduction of air pressure in persons who have been breathing compressed air while diving.
SYMPTOMS—This illness is characterized by joint pains, neurological symptoms, loss of consciousness, and sudden onset.
TREATMENT—As soon as symptoms are reported, oxygen is given with the patient prone and the head slightly lowered. Refer immediately to the nearest recompression facility.
Pulmonary Edema
This is an acute medical emergency. It may be caused by drugs such as heroin, irritant gases, burns, or blast percussion, causing injury to the alveolar-capillary membrane. However, it is usually the result of left ventricular failure or mitral stenosis.
SYMPTOMS—Onset may be abrupt or insidious, Cough, asthmatic wheezing, dyspnea, and orthopnea (inability to breathe except in an upright position) occur in the early stages. Later marked anxiety; gasping for breath; pink, frothy sputum; terror; anguish; profuse sweating; cyanosis; paroxysmal coughing; rales; thin, rapid pulse; and falling hood pressure occur.
TREATMENT—Place the patient in an upright position to relieve orthopnea. Morphine has long been the sovereign drug in the initial emergency treatment and many mild to moderate episodes have been relieved by morphine alone. Oxygen, intermittent positive pressure breathing, rapid venesection (to reduce circulating blood volume) or rotating tourniquets, and pulmonary drainage with maintenance of the airway are used in severe progressive forms. Rapid digitalization is indicated once heart failure has been established and after it has been determined that the patient has not been completely or over digitalized. Digitalk intoxication may cause acute pulmonary edema.
DISEASES OF THE GASTROINTESTINAL (GI) TRACT
The following are some of the more commonly encountered diseases of the GI tract.
Diarrhea
Diarrhea may be caused by a wide variety of intestinal disorders, such as viral enteritis, salmonellosis, or amebiasis, or it may be psychogenic in origin. It may also be caused by metabolic diseases, dietary factors, or food allergies.
TREATMENT—Eliminate any specific causes. Place the patient on a liquid diet for the first 24 hours and then, if tolerated, a soft diet. Antidiarrheal agents such as Kaopectate® or Lomotil® should be used with caution. In cases of bacterial infection, antidiarrheal agents may prolong the infection and/or carrier states of the infection.
Pyrosis
Pyrosis (heartburn) is a burning substernal pain resulting from irritation of the distal esophagus.
TREATMENT—Treatment normally consists of antacids and a bland diet. Elevating the head of the bed, weight redtiction, avoiding tight clothing, and other symptomatic treatment have proven beneficial.
Constipation
Constipation is the result of lesions of the colon and rectum, hypometabolism, neurosis, improper fluid intake, and drug ingestion. Constipation should be considered only in patients who have been unable to move their bowels for several days or if the stools are very hard or dry. 2-9