When other pain-relieving drugs are not available
and the patient in shock or with burns is in severe pain,
20 mg of morphine may be given intramuscularly
(followed by massage of the injection site). Resist the
temptation to give more, however. Unless otherwise
ordered by a medical officer, doses should not be
repeated more than twice, and then at least 4 hours
apart.
If the pain from a wound is severe, morphine may
be given when examination of the patient reveals no
head injury;
chest injury, including sucking and nonsucking
wounds;
wounds of the throat, nasal passages, oral cavity,
or jaws wherein blood might obstruct the airway;
massive hemorrhage;
respiratory impairment, including chemical
burns of the respiratory tract (any casualty
having fewer than 16 respirations per minute
should not be given morphine);
evidence of severe or deepening shock; or
loss of consciousness.
CASUALTY MARKING
Morphine overdose is always a danger. For this
reason, plainly identify every casualty who has received
morphine. Write the letter M and the hour of injection
on the patients forehead (e.g., M0830) with a skin
pencil or semi-permanent marking substitute. Attach
the empty morphine syrette or tubex to the patients shirt
collar or another conspicuous area of the clothing with a
safety pin or by some other means. This action will alert
others that the drug has been administered. If a Field
Medical Card is prepared, record the dosage, time, date,
and route of administration.
COMMON MEDICAL EMERGENCIES
LEARNING OBJECTIVE: Choose the
appropriate treatment and management
techniques for the common medical
emergencies.
This section of the chapter deals with relatively
common medical emergencies a Hospital Corpsman
may face. Generally speaking, these particular
problems are the result of previously diagnosed
medical conditions; so, at least for the victim, they do
not come as a complete surprise.
Many of these
victims wear a medical identification device (necklace
or bracelet), or carry a medical identification card that
specifies the nature of the medical condition or the type
of medications being taken. In all cases of sudden
illness, search the victim for a medical identification
device.
SYNCOPE
Uncomplicated syncope (fainting) is the result of
blood pooling in dilated veins, which reduces the
amount of blood being pumped to the brain. Causes of
syncope include getting up too quickly, standing for
long periods with little movement, and stressful
situations. Signs and symptoms that may be present
are dizziness; nausea; visual disturbance from
pupillary dilation; sweating; pallor; and a weak, rapid
pulse. As the body collapses, blood returns to the head,
and consciousness is quickly regained. Revival can be
promoted by carefully placing the victim in the shock
position or in a sitting position with the head between
the knees. Placing a cool, wet cloth on the patients
face and loosening their clothing can also help.
Syncope may also result from an underlying
medical problem such as diabetes, cerebrovascular
accident (stroke), heart condition, or epilepsy.
DIABETIC CONDITIONS
Diabetes mellitus is an inherited condition in
which the pancreas secretes an insufficient amount of
the protein hormone insulin.
Insulin regulates
carbohydrate metabolism by enabling glucose to enter
cells for use as an energy source. Diabetics almost
always wear a medical identification device.
Diabetic Ketoacidosis
Diabetic ketoacidosis most often results either
from forgetting to take insulin or from taking too little
insulin to maintain a balanced condition. Diabetics
may suffer from rising levels of glucose in the blood
stream (hyperglycemia). The rising levels of glucose
result in osmotic diuresis, an increased renal excretion
of urine.
Serious dehydration (hypovolemia) may
result. Concurrently, the lack of glucose in the cells
leads to an increase in metabolic acids in the blood
(acidosis) as other substances, such as fats, are
metabolized as energy sources. The result is gradual
central nervous system depression, starting with
symptoms of confusion and disorientation, and leading
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