bubbles at the nose and mouth and distinctive rattlingsounds (known as rales) in the chest. Increased bloodpressure may also cause body fluids to pool in theextremities.Emergency treatment for congestive heart failureis essentially the same as that for acute myocardialinfarction. Do not start CPR unless the patient’s heartfunction ceases. If an intravenous line is started, itshould be maintained at the slowest rate possible tokeep the vein open since an increase in the circulatoryvolume will make the condition worse. Immediatelytransport the patient to a medical treatment facility.CONVULSIONSConvulsions, or seizures, are a startling and oftenf 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 echaracterized by severe and uncontrolled musclespasms or muscle rigidity. Convulsive episodes occurin one to two percent of the general population.Although epilepsy is the most widely known formof seizure activity, there are numerous forms ofconvulsions that are classified as either central nervoussystem (CNS) or non-CNS in origin. It is especiallyimportant to determine the cause in patients who haveno previous seizure history. This determination mayrequire an extensive medical workup in the hospital.Since epilepsy is the most widely known form ofseizure activity, this section will highlight epilepticseizure disorders.Epilepsy, also known as seizures or fits, is acondition characterized by an abnormal focus ofactivity in the brain that produces severe motorresponses or changes in consciousness. Epilepsy mayresult from head trauma, scarred brain tissue, braintumors, cerebral arterial occlusion, fever, or a numberof other factors. Fortunately, epilepsy can often becontrolled by medications.Grand mal seizure is the more serious type ofepilepsy. Grand mal seizure may bebut is notalwayspreceded by an aura. The victim soon comesto recognize these auras, which allows him time to liedown and prepare for the seizure’s onset. A burst ofnerve impulses from the brain causes unconsciousnessand generalized muscular contractions, often with lossof bladder and bowel control. The primary dangers in agrand mal seizure are tongue biting and injuriesresulting from falls. A period of sleep or mentalconfusion follows this type of seizure. When fullconsciousness returns, the victim will have little or norecollection of the attack.Petit mal seizure is of short duration and ischaracterized by an altered state of awareness or partialloss of consciousness, and localized muscularcontractions. The patient has no warning of theseizure’s onset and little or no memory of the attackafter it is over.First aid treatment for both types of epilepticseizure consists of protecting the victim fromself-injury. Additional methods of seizure control maybe employed under a medical officer’s supervision. Inall cases, be prepared to provide suction to the victimsince the risk of aspiration is significant. Transport thepatient to a medical treatment facility once the seizurehas ended.DROWNINGDrowning is a suffocating condition in a waterenvironment. Water seldom enters the lungs inappreciable quantities because, upon contact withfluid, laryngeal spasms occur, and these spasms sealthe airway from the mouth and nose passages. Toavoid serious damage from the resulting hypoxia,quickly bring the victim to the surface andimmediatelyeven before the victim is pulled toshorestart artificial ventilation. Do not interruptartificial ventilation until the rescuer and the victim areashore. Once on dry ground, quickly administer anabdominal thrust (Heimlich maneuver) to empty thelungs, and then immediately restart the ventilationuntil spontaneous breathing returns. Oxygenenrichment is desirable if a mask is available.Remember that an apparently lifeless person whohas been immersed in cold water for a long period oftime may be revived if artificial ventilation is startedimmediately.PSYCHIATRIC EMERGENCIESA psychiatric emergency is defined as a suddenonset of behavioral or emotional responses that, if notresponded to, will result in a life-threatening situation.Probably the most common psychiatric emergency isthe suicide attempt. A suicide attempt may range fromverbal threats and suicidal gestures to a successfulsuicide. Always assume that a suicide threat is real; donot leave the patient alone. In all cases, the primeconsideration for a Hospital Corpsman is to keeppatients from inflicting harm to themselves and to getthem under the care of a trained psychiatricprofessional. When dealing with suicidal gestures orattempts, treat any self-inflicted wounds appropriately.4-69
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