When other pain-relieving drugs are not availableand 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 thetemptation to give more, however. Unless otherwiseordered by a medical officer, doses should not berepeated more than twice, and then at least 4 hoursapart.If the pain from a wound is severe, morphine maybe given when examination of the patient reveals nohead injury;chest injury, including sucking and nonsuckingwounds;wounds of the throat, nasal passages, oral cavity,or jaws wherein blood might obstruct the airway;massive hemorrhage;respiratory impairment, including chemicalburns of the respiratory tract (any casualtyhaving fewer than 16 respirations per minuteshould not be given morphine);evidence of severe or deepening shock; orloss of consciousness.CASUALTY MARKINGMorphine overdose is always a danger. For thisreason, plainly identify every casualty who has receivedmorphine. Write the letter “M” and the hour of injectionon the patient’s forehead (e.g., M0830) with a skinpencil or semi-permanent marking substitute. Attachthe empty morphine syrette or tubex to the patient’s shirtcollar or another conspicuous area of the clothing with asafety pin or by some other means. This action will alertothers that the drug has been administered. If a FieldMedical Card is prepared, record the dosage, time, date,and route of administration.COMMON MEDICAL EMERGENCIESLEARNING OBJECTIVE: Choose theappropriate treatment and managementtechniques for the common medicalemergencies.This section of the chapter deals with relativelycommon medical emergencies a Hospital Corpsmanmay face. Generally speaking, these particularproblems are the result of previously diagnosedmedical conditions; so, at least for the victim, they donot come as a complete surprise. Many of thesevictims wear a medical identification device (necklaceor bracelet), or carry a medical identification card thatspecifies the nature of the medical condition or the typeof medications being taken. In all cases of suddenillness, search the victim for a medical identificationdevice.SYNCOPEUncomplicated syncope (fainting) is the result ofblood pooling in dilated veins, which reduces theamount of blood being pumped to the brain. Causes ofsyncope include getting up too quickly, standing forlong periods with little movement, and stressfulsituations. Signs and symptoms that may be presentare dizziness; nausea; visual disturbance frompupillary dilation; sweating; pallor; and a weak, rapidpulse. As the body collapses, blood returns to the head,and consciousness is quickly regained. Revival can bepromoted by carefully placing the victim in the shockposition or in a sitting position with the head betweenthe knees. Placing a cool, wet cloth on the patient’sface and loosening their clothing can also help.Syncope may also result from an underlyingmedical problem such as diabetes, cerebrovascularaccident (stroke), heart condition, or epilepsy.DIABETIC CONDITIONSDiabetes mellitus is an inherited condition inwhich the pancreas secretes an insufficient amount ofthe protein hormone insulin. Insulin regulatescarbohydrate metabolism by enabling glucose to entercells for use as an energy source. Diabetics almostalways wear a medical identification device.Diabetic KetoacidosisDiabetic ketoacidosis most often results eitherfrom forgetting to take insulin or from taking too littleinsulin to maintain a balanced condition. Diabeticsmay suffer from rising levels of glucose in the bloodstream (hyperglycemia). The rising levels of glucoseresult in osmotic diuresis, an increased renal excretionof urine. Serious dehydration (hypovolemia) mayresult. Concurrently, the lack of glucose in the cellsleads to an increase in metabolic acids in the blood(acidosis) as other substances, such as fats, aremetabolized as energy sources. The result is gradualcentral nervous system depression, starting withsymptoms of confusion and disorientation, and leading4-66
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