.  Sensory  System—Test  for  sensations using  pain,  heat  or  cold,  touch,  and  vibration. .  Reflexes-Check  deep  tendon  reflexes, superficial    reflexes, and   also   check   the pathological  reflexes  (i.e.,  Brudzinski’s  sign  and Kernig’s  sign).  Reflexes  are  checked  to  localize nervous  system  disorders. RADIOING  FOR  ADVICE After  taking  the  history  and  performing  the physical examination, make an assessment of the patient’s condition related to all positive findings. Independent  duty  hospital  corpsmen  usually  have the  most  modern  communications  facilities  at their disposal and should never have to guess. If you are in doubt as to the diagnosis, seek advice. Ship’s  information  such  as  latitude,  longitude, destination, and the like will be provided by the responsible  section.  Message  format  is  likewise available   from   the   communications   section. Where to seek help is an administrative problem since  the  location  of  ships  with  medical  officers aboard  is  not  in  the  purview  of  the  corpsman. However,  you  are  responsible  for  the  content  of the  message  and  should  provide  all  essential information.  Give  the  patient’s  full  name,  rate, SSN,   age,   mental   state,   and   ship   to   which attached.  List  the  principal  complaint,  nature  and onset of symptoms, and also their duration. List the  associated  symptoms,  and  list  personal  and work habits that may have a bearing on the case. If  injured,  give  the  cause,  location,  amount  of bleeding,  deformity,  and  any  other  significant signs and symptoms. State the patient’s vital signs and their trends, if any. List all other pertinent physical  findings,    results   of   tests,   and   any treatment started. ACUTE  THORACIC  EMERGENCIES For  acute  thoracic  emergencies: Establish and maintain and open airway. Keep  the  patient  well  oxygenated  and,  if necessary,  use  artificial  respiration  and intermittent  positive  pressure  oxygen. Avoid  using  sedatives  that  depress  the respiratory  center  (i.e.,  narcotics). Counteract  shock  and  maintain  an  ade- quate  level  of  circulating  blood  volume. DISEASES OF THE RESPIRATORY  TRACT The following are some of the more commonly encountered  diseases  of  the  respiratory  tract. Upper Respiratory Infection (URI) In most cases, the signs and symptoms listed below  indicate  a  severe  URI  and  a  need  for medical  assistance. An elevated temperature of 101°F or more that  has  persisted  for  3  or  more  days. A white or dirty gray exudate in the throat. Diffuse  reddening  of  the  throat. A  persistent  cough  of  2  or  more  weeks. Complicating  symptoms  that  you  should be  alert  for  are  skin  rashes,  stiff  neck, muscular  weakness,  and  swelling. Pneumococcal  Pneumonia ETIOLOGY—This  is  an  acute  inflammatory process   in   the   alveolar   spaces   of   the   lung. Pneumococcus  accounts  for  approximately  60  to 80 percent of all primary bacterial pneumonias. Because  bacterial  pneumonias  are  usually  second- ary  to  injury  of  the  respiratory  mucosa  by  viral infections  such  as  influenza  and  the  common  cold, they often occur during periods of cold, inclement weather. SYMPTOMS—There   is   a   sudden   onset   of symptoms with rapid progression. The condition of the patient deteriorates rapidly. Temperatures range form 100° to 105°F, pulse rate may go as high   as   160,   and   respiration   is   marked   by tachypnea (30 to 40 per minute). Respirations are shallow  and  a  peculiar  “grunt”  may  be  heard upon expiration; the patient will often lie on the affected side in an effort to splint the chest. The patient  experiences  hard,  shaking  chills;  sharp, stabbing  chest  pains  that  are  exaggerated  by respiration;   and   a   productive   cough   with “rusty”  colored  sputum.  Upon  auscultation,  fine inspiratory  rales  may  be  heard,  followed  by  the classic  signs  of  consolidation  (absent  breath sounds  and  dullness).  Sometimes  the  abdomen becomes distended and a pleural friction rub may be  heard. 2-6