Some  indications  for  use  of  the  pneumatic counter-pressure  devices  are  as  follows: 1. Systolic blood pressure less than 80 mm Hg 2.  Systolic  blood  pressure  less  than  100  mm Hg and the patient exhibits the classic signs of  shock 3. Fracture of the pelvis or lower extremities. The only absolute contraindication in their use  is  pulmonary  edema,  although  condi- tional contraindications include congestive heart  failure,  heart  attack,  stroke,  preg- nancy,   abdominal   evisceration,   massive bleeding  into  the  thoracic  cavity,  and penetrating wounds where the object is still impaled in the victim. Application  of  the  anti-shock  garment  is  a relatively  simple  procedure  but  requires  some  im- portant preliminary steps. When the garment is laid out flat, ensure that there are no wrinkles. If  clothing  is  to  remain  on  the  patient,  remove all  sharp  and  bulky  objects  from  the  patient’s pockets. Take vital signs before applying the gar- ment. The garments are inflated only sufficiently to  bring  the  patient’s  systolic  blood  pressure  to 100 mm Hg and maintain it there. Once the gar- ment  is  inflated,  take  vital  signs  every  5  minutes. The  garment  is  removed  only  under  the  direct supervision of a physician, There is no indication for  the  pre-hospital  removal  of  anti-shock garments. Other shock treatment procedures to use are as  follows: 1.  Maintain  an  open  airway.  Oxygen  may  also be  administered  if  proper  equipment  is available. 2.   Control   hemorrhage. 3.  Check  for  other  injuries  that  may  have been  sustained.  Remove  the  victim  from the   presence   of   identifiable   causative agents. 4. Place the victim in a supine position, with the feet slightly higher than the head (shock position).  Certain  problems,  such  as breathing  difficulties  or  head  injuries,  may require  other  positioning. 5.  Reduce  pain  by  splinting  fractures,  pro- viding  emotional  support,  and  attending  to the  victim’s  comfort.  Unless  contrain- dicated,  aspirin  may  be  dispensed. 6.  Conserve  body  heat. 7.  Avoid  rough  handling  and  transport  the victim  to  a  medical  treatment  facility. 8.  If  transportation  to  a  definitive  care  facility will be lengthy or delayed, seek the radio or  phone  advice  of  a  medical  officer  on whether or not to give fluids by mouth or to start an intravenous line. If this is im- possible,   use   your   own   judgment.   Car- diogenic shock is the only exception to this rule.   DO   NOT   start   intravenous   fluids since  volume  is  sufficient  and  only  func- tion  is  impaired. 9. Constantly monitor and record vital signs every  15  minutes  so  that  you  are  able  to keep  track  of  the  victim’s  progress. PAIN RELIEF As  a  corpsman  in  the  field  or  on  board  ship in wartime, you may be issued morphine for the control  of  shock  through  relief  of  severe  pain. You  will  be  issued  this  controlled  drug  under  very strict  accountability  procedures.  Possession  of  this drug is a medical responsibility that must not be taken lightly. Morphine Administration Morphine  is  the  most  effective  of  all  pain- relieving drugs. It is most commonly available in syrettes or tubex in premeasured doses. Properly administered in selected patients, it will relieve distressing  pain  and  assist  in  the  prevention  of shock. The adult dose of morphine is 8 to 16 mg repeated, if necessary, in not less than 4 hours. Morphine   has   several   undesirable   effects, however, and   these   must   be   thoroughly understood  by  the  corpsman. 1. Morphine is a severe respiratory depressant and therefore must not be given to patients in moderate or severe shock or to patients in respiratory distress. 2.  Morphine  increases  intracranial  pressure and may induce vomiting; these effects may be disastrous in head injury cases. 3. Morphine causes constriction of the pupils (pinpoint pupils); this effect prevents the use  of  the  pupillary  reactions  for  diagnosis in head injuries. 4.  Morphine  is  cardiotoxic  and  a  peripheral vasodilator. It  may  cause  profound hypotension in small doses in the patient in  shock. 5.   Morphine   poisoning   is   an   ever-present danger.  There  is  a  narrow  safety  margin between the amounts of morphine that may 4-50