with subdural hematoma will experience facial muscle weakness.
TREATMENT—Ensure that the patient has a patent airway. If oxygen is to be administered, a nasal catheter is the preferred method of administration. Manipulation such as suturing or setting fractures should be held to a minimum, if possible, until the patient’s condition is stable. If the patient demonstrates extreme restlessness that may further complicate his or her condition, sedate quickly; otherwise avoid sedation. DO NOT attempt to stem bleeding or the escape of fluids from the ears or nose. Tell the patient to try to avoid sneezing, coughing, or blowing the nose. Evacuate the patient immediately.
Herniated Disk
In most cases, herniation or rupture of an intervertebral disk is the result of trauma. It may occur with sudden straining of the back in an odd position or while lifting in the trunk flex position. Herniation may occur immediately or may take years to occur. Most herniation occurs in the lumbosacral area but may also occur in the cervical or thoracic regions.
SYMPTOMS—Over 90 percent of all herniated disks occur at the fourth or fifth lumbar interspace. There is pain upon palpation, and the patient will have a limited range of motion. The posture of the spine will be abnormal due to the loss of curvature of the spine. The patient may exhibit mild weakness of the foot or extensor areas of the great toe. There may be impaired sensations of pain or touch, and coughing or sneezing may cause radiation of the pain to the calf.
TREATMENT—Place the patient on bed rest with a backboard and administer analgesics for pain. If possible, apply traction and prevent the patient from using any severe physical effort. Applications of heat to the area of tenderness is beneficial. Definitive treatment of herniated disks will normally require surgery. Therefore, evacuate the patient as soon as possible.
PSYCHIATRIC DISORDERS
Psychiatric disorders are more commonly encountered now than at anytime in the past. This is due in part to improved diagnostic techniques, changing technology, and many other factors. Psychiatric disorders run the gamut from anxiety reactions to schizophrenia. The independent duty hospital corpsman is not properly trained to treat acute psychiatric disorders. He should, however, be familiar with the signs and symptoms of psychiatric disorders and be able to manage those individuals who may be a threat to themselves or to other personnel.
Classification of Psychiatric Disorders
The major classifications of psychiatric disorders are neuroses, psychoses, and personality disorders.
Neuroses—Emotional maladjustments that may impair thinking and judgment, but cause minimal loss of contact with reality. Neuroses often manifest themselves in the form of anxiety reactions, phobias, and obsessive depressive states. (Suicide is a definite possibility in depressive states.) The management of individuals with neuroses includes removing them from stressful environments, listening, and the presentation of alternatives versus being given advice.
Psychoses—Mental disorders in which mental functioning is so impaired that it interferes with the capacity of the individuals to meet the ordinary demands of life. These disorders manifest themselves in the form of schizophrenia, psychotic depression, and paranoid reactions. Tranquilizers and antipsychotic medications may be necessary to protect the patient if immediate evacuation is not possible.
Personality Disorders—Characterized by relatively fixed and inflexible lifelong reactions to stress. Common personality disorders include hysterias and antisocial, paranoid, obsessive compulsive, passive aggressive, and inadequate personalities. The processing of personality disorders is administrative in nature and medical department responsibilities in managing them may be limited to confirmation and counseling.
ENDOCRINE DISORDERS
The following are some of the more commonly encountered disorders of the endocrine system.
Diabetes Mellitus
This is a hereditary disease characterized by an inadequate secretion and production of insulin
