In the case of ingested substances, do not induce
vomiting in a patient who is not awake and alert. For
specific treatment of ingested substances, refer to the
section on poisons in chapter 5.
There are numerous other psychiatric conditions
that would require volumes to expound upon. In
almost all cases, appropriate first aid treatment
consists of a calm, professional, understanding
demeanor that does not aggravate or agitate the patient.
With an assaultive or hostile patient, a “show of force”
may be all that is required. Almost all cases of
psychiatric emergencies will present with a third
party]often the family or friend of the patientwho
has recognized a distinct change in the behavior
pattern of the patient and who is seeking help for them.
DERMATOLOGIC EMERGENCIES
Most dermatologic cases that present as
emergencies are not real emergencies. The patient
perceives them as such because of the sudden
presentation and/or repulsive appearance or excessive
discomfort. Treat most dermatologic conditions
s y m p t o m a t i c a l l y.
T h e m a j o r e x c e p t i o n t o
symptomatic treatment is toxic epidermal necrolysis
(TEN).
Toxic epidermal necrolysis is a condition
characterized by sudden onset, excessive skin
irritation, painful erythema (redness of skin produced
by congestion of the capillaries), bullae (large
blisters), and exfoliation of the skin in sheets. TEN is
also known as the scalded skin syndrome because of
its appearance. TEN is thought to be caused by a
staphylococcal infection in children and by a toxic
reaction to medications in adults.
Since skin is the largest single organ of the body
and serves as a barrier to infection, prevention of
secondary skin infection is very important. Treatment
of skin infections consists of isolation techniques,
silver nitrate compresses, aggressive skin care,
intravenous antibiotic therapy and, in drug-induced
cases, systemic steroids.
EMERGENCY CHILDBIRTH
Every Hospital Corpsman must be prepared to
handle the unexpected arrival of a new life into the
world. If the Corpsman is fortunate, a prepackaged
sterile delivery pack will be available. This pack will
contain all the equipment needed for the normal
delivery of a healthy baby. If the pack is not available,
a Hospital Corpsman will require imaginative
improvisation of clean alternatives.
When faced with an imminent childbirth, the
Hospital Corpsman must first determine whether there
will be time to transport the expectant mother to a
hospital.
To help make this determination, the
Corpsman should try to find out
if this will be the woman’s first delivery (first
deliveries usually take much longer than
subsequent deliveries);
the time between contractions (if less than 3
minutes, delivery is approaching);
if the mother senses that she has to move her
bowels (if so, then the baby’s head is well
advanced down the birth canal);
if there is crowning (bulging) of the orifice
(crowning indicates that the baby is ready to
present itself); and
how long it will take to get to the hospital.
The Corpsman must weigh the answers to these
questions and decide if it will be safe to transport the
patient to the hospital.
Prior to childbirth, a Corpsman must quickly “set
the stage.” The mother must not be allowed to go to the
bathroom since straining may precipitate delivery. Do
not try to inhibit the natural process of childbirth. The
mother should lie back on a sturdy table, bed, or
stretcher with a folded sheet or blanket placed under
her buttocks for absorption and comfort. Remove all
the patient’s clothing below the waist, bend the knees,
move the thighs apart, and drape her lower extremities
with clean towels or sheets. Don sterile gloves, or, if
these are not available, rewash your hands.
In a normal delivery, your calm professional
manner and sincere reassurance to the mother will
reduce her anxiety and make the delivery easier for
everyone. Help the woman rest and relax as much as
possible between contractions. During a contraction,
deep, open-mouth breathing will relieve some pain and
straining. As the child’s head reaches the area of the
rectum, the mother will feel an urgent need to defecate.
Reassurance that this is a natural feeling and a sign that
the baby will be born soon will help alleviate her
apprehension.
Watch for the presentation of the top of the baby’s
head. Once the head appears, take up your station at
the foot of the bed and gently push against the head to
keep it from emerging too quickly. Allow it to come
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