bubbles at the nose and mouth and distinctive rattling sounds (known as rales) in the chest. Increased blood pressure may also cause body fluids to pool in the extremities. Emergency treatment for congestive heart failure is essentially the same as that for acute myocardial infarction. Do not start CPR unless the patient’s heart function ceases. If an intravenous line is started, it should be maintained at the slowest rate possible to keep the vein open since an increase in the circulatory volume will make the condition worse. Immediately transport the patient to a medical treatment facility. CONVULSIONS Convulsions, or seizures, are a startling and often f r i g h t e n i n g p h e n o m e n o n . C o n v u l s i o n s a r e characterized by severe and uncontrolled muscle spasms or muscle rigidity. Convulsive episodes occur in one to two percent of the general population. Although epilepsy is the most widely known form of seizure activity, there are numerous forms of convulsions that are classified as either central nervous system (CNS) or non-CNS in origin. It is especially important to determine the cause in patients who have no previous seizure history. This determination may require an extensive medical workup in the hospital. Since epilepsy is the most widely known form of seizure activity, this section will highlight epileptic seizure disorders. Epilepsy, also known as seizures or fits, is a condition characterized by an abnormal focus of activity in the brain that produces severe motor responses or changes in consciousness. Epilepsy may result from head trauma, scarred brain tissue, brain tumors, cerebral arterial occlusion, fever, or a number of other factors. Fortunately, epilepsy can often be controlled by medications. Grand mal seizure is the more serious type of epilepsy. Grand mal seizure may bebut is not alwayspreceded by an aura. The victim soon comes to recognize these auras, which allows him time to lie down and prepare for the seizure’s onset. A burst of nerve impulses from the brain causes unconsciousness and generalized muscular contractions, often with loss of bladder and bowel control. The primary dangers in a grand mal seizure are tongue biting and injuries resulting from falls. A period of sleep or mental confusion follows this type of seizure. When full consciousness returns, the victim will have little or no recollection of the attack. Petit mal seizure is of short duration and is characterized by an altered state of awareness or partial loss of consciousness, and localized muscular contractions. The patient has no warning of the seizure’s onset and little or no memory of the attack after it is over. First aid treatment for both types of epileptic seizure consists of protecting the victim from self-injury. Additional methods of seizure control may be employed under a medical officer’s supervision. In all cases, be prepared to provide suction to the victim since the risk of aspiration is significant. Transport the patient to a medical treatment facility once the seizure has ended. DROWNING Drowning is a suffocating condition in a water environment. Water seldom enters the lungs in appreciable quantities because, upon contact with fluid, laryngeal spasms occur, and these spasms seal the airway from the mouth and nose passages. To avoid serious damage from the resulting hypoxia, quickly bring the victim to the surface and immediatelyeven before the victim is pulled to shorestart artificial ventilation. Do not interrupt artificial ventilation until the rescuer and the victim are ashore. Once on dry ground, quickly administer an abdominal thrust (Heimlich maneuver) to empty the lungs, and then immediately restart the ventilation until spontaneous breathing returns. Oxygen enrichment is desirable if a mask is available. Remember that an apparently lifeless person who has been immersed in cold water for a long period of time may be revived if artificial ventilation is started immediately. PSYCHIATRIC EMERGENCIES A psychiatric emergency is defined as a sudden onset of behavioral or emotional responses that, if not responded to, will result in a life-threatening situation. Probably the most common psychiatric emergency is the suicide attempt. A suicide attempt may range from verbal threats and suicidal gestures to a successful suicide. Always assume that a suicide threat is real; do not leave the patient alone. In all cases, the prime consideration for a Hospital Corpsman is to keep patients from inflicting harm to themselves and to get them under the care of a trained psychiatric professional. When dealing with suicidal gestures or attempts, treat any self-inflicted wounds appropriately. 4-69