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COMMON MEDICAL EMERGENCIES
LEARNING OBJECTIVE: Choose the
appropriate treatment and management
techniques for the common medical emergencies.
This section of the chapter deals with relatively
common medical emergencies a Hospital Corpsman
may face. Generally speaking, these
particular problems are the result of
previously diagnosed medical
conditions; so, at least for the victim, they do
not come as a complete surprise. Many of these
victims wear a medical identification device
(necklace or bracelet), or carry a
medical identification card that
specifies the nature of the medical condition or the type
of medications being taken. In all cases of
sudden illness, search the victim for a
medical identification device.
SYNCOPE
Uncomplicated syncope (fainting) is the result of
blood pooling in dilated veins, which reduces the
amount of blood being pumped to the brain.
Causes of syncope include getting up
too quickly, standing for long periods
with little movement, and stressful
situations. Signs and symptoms that may be present
are dizziness; nausea; visual disturbance
from pupillary dilation; sweating;
pallor; and a weak, rapid pulse. As the
body collapses, blood returns to the head,
and consciousness is quickly regained. Revival can be
promoted by carefully placing the victim in
the shock position or in a sitting
position with the head between the
knees. Placing a cool, wet cloth on the patient's
face and loosening their clothing can also help.
Syncope may also result from an underlying
medical problem such as diabetes, cerebrovascular
accident (stroke), heart condition, or
epilepsy.
DIABETIC CONDITIONS
Diabetes mellitus is an inherited condition in
which the pancreas secretes an insufficient amount of
the protein hormone insulin. Insulin
regulates carbohydrate metabolism by
enabling glucose to enter cells for use
as an energy source. Diabetics almost
always wear a medical identification device.
Diabetic Ketoacidosis
Diabetic ketoacidosis most often results either
from forgetting to take insulin or from taking too little
insulin to maintain a balanced condition.
Diabetics may suffer from rising levels
of glucose in the blood stream
(hyperglycemia). The rising levels of glucose
result in osmotic diuresis, an increased renal excretion
of urine. Serious dehydration (hypovolemia)
may result. Concurrently, the lack of
glucose in the cells leads to an
increase in metabolic acids in the blood
(acidosis) as other substances, such as fats, are
metabolized as energy sources. The result is
gradual central nervous system
depression, starting with symptoms of
confusion and disorientation, and leading
to stupor and coma. Blood pressure falls, and the pulse
rate becomes rapid and weak. Respirations
are deep, and a sickly sweet acetone
odor is present on the breath. The skin
is warm and dry.
NOTE: Diabetic victims are often mistakenly
treated as if intoxicated since the signs and
symptoms presented are similar to those
of alcohol intoxication.
The diabetic under treatment tries to balance the
use of insulin against glucose intake to avoid the above
problems. The victim or the victim's family
may be able to answer two key questions:
1. Has the victim eaten today?
2. Has he taken the prescribed insulin?
If the answer is yes to the first and no to the second
question, the victim is probably in a
diabetic coma.
Emergency first aid centers around ABC support,
administration of oral or intravenous fluids to counter
shock, and rapid evacuation to a medical
officer's supervision.
Insulin Shock
Insulin shock results from too little sugar in the
blood (hypoglycemia). This type of shock
develops when a diabetic exercises too much
or eats too little after taking
insulin. Insulin shock is a very serious
condition because glucose is driven into the cells to be
metabolized, leaving too little glucose in
circulation to support the brain. Brain
damage develops quickly. Signs and
symptoms of insulin shock include
· pale, moist skin;
· dizziness and headache;
· strong, rapid pulse; and
· fainting, seizures, and coma.
Treatment is centered on getting glucose into the
system quickly to prevent brain damage. Placing sugar
cubes under the tongue or administering oral
liquid glucose are the most beneficial
treatments. Transport the victim to a
medical treatment facility as soon as
possible.
NOTE: If you are in doubt as to whether the
victim is in insulin shock or a ketoacidotic
state, give them sugar. Brain damage
develops very quickly in insulin shock
and must be reversed immediately. If
the victim turns out to be
ketoacidotic, a condition that progresses
slowly, the extra sugar will do no appreciable
harm.
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