Operational Medicine 2001
Standard First Aid Course
NAVEDTRA 13119

Medical Emergencies

Medical emergencies are defined as an unexpected or sudden occasion; an accident; an urgent or pressing need.

Fainting

Fainting, also known as syncope is a temporary loss of consciousness. It is the result of blood pooling in large (dilated) veins, which reduces the amount of blood being pumped to the brain. Causes include getting up too fast, standing for long periods with little movement, and stressful situations. Fainting also may result from an underlying medical problem such as diabetes, stroke, or heart problems. Signs and symptoms of fainting include:

1. Dizziness, nausea, and visual problems.

2. Sweating, paleness, weakness, and rapid pulse.

As the body collapses, blood returns to the head and consciousness is quickly regained. If the casualty has fainted, do the following:

1. Perform an initial assessment.

2. Place the casualty on his or her back, with legs elevated 6 to 12 inches. Do not allow casualty to sit up.

3. Monitor the airway, breathing, and circulation (ABCs).

4. Loosen restrictive clothing, at the neck, waist, and chest.

5. Check the casualty for injuries suffered during the fall.

6. Request medical assistance for fainting as needed.

Chest Injuries

All chest injuries must be considered serious, because they can cause difficulty breathing (dyspnea) and severe bleeding. Any casualty complaining of difficulty breathing without signs of an airway obstruction must be examined for either an open or closed chest injury.

The most serious chest wound that requires immediate first aid is a sucking chest wound (Open Pneumothorax). This is a penetrating injury that makes a hole in the chest cavity, causing the lung to collapse, which prevents normal breathing. This condition is a medical emergency that will result in death if not treated quickly. Signs and symptoms of a sucking chest wound include:

1. Difficulty breathing and sharp chest pain.

2. Bluish skin color and anxiety.

If the casualty has a sucking chest wound, do the following:

1. Immediately seal the wound with your hand or any airtight (I.D. Card) material available. The material must be large enough so that it will not be sucked into the wound when the casualty breaths.

2. Firmly tape the material in place with adhesive tape leaving one corner untaped to prevent a pressure buildup. The purpose of the dressing is to keep air from going in through the wound. If the casualty's condition deteriorates, remove the seal immediately.

3. Lay the casualty on his or her affected side.

4. Treat for shock - Place the casualty in a semi-sitting position, to help them breath easier.

5. Do not give the casualty anything to eat or drink. If the casualty complains of thirst, wet his or her lips with a wet towel.

6. Request medical assistance immediately.

Flail Chest

A medical emergency in which two or more ribs are broken, each in at least two places; or a fracture or separation of the ribs from the breastbone producing a free-floating segment. This segment is called the "flail area," its motion is opposite the rest of the chest. The area between the fractures moves in the opposite direction of the rest of the chest during ventilation. This condition can be life-threatening because it may bruise the lung beneath the flail area. The bone ends may also puncture a lung and cause severe bleeding, which can produce shock. It may be difficult to detect a flail chest in an obese or muscular casualty. Signs and symptoms of flail chest include:

1. Difficulty breathing that causes severe pain.

2. Swelling at site of injury.

3. Casualty will splint his/her chest wall with hands and arms.

If the casualty has a flail chest, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Gently feel the chest to locate the edges of the flail area.

3. Stabilize the flail area with a pad of dressings or a pillow and secure with wide cravats.

4. Position the casualty with the flail area against an external object in a semi-sitting position or lying on the injured side.

5. Treat for shock.

6. Request medical assistance immediately.

Abdominal Injuries

Abdominal injuries are caused by severe blows, gunshots, and stabbings. They can easily become a medical emergency because of the vital organs that may be damaged. Most injuries to the abdomen require surgery to repair the internal damage.

Closed

Closed abdominal injuries are caused by a severe blow or crushing injury, where the skin remains intact. Death is usually caused by bleeding into the abdomen. A complication known as peritonitis, usually the result of a rupture of the intestines, is not seen immediately but develops later and can be fatal. Signs and symptoms of (closed) abdominal injury include:

1. Intense pain, nausea, vomiting, and spasm of the abdominal muscle.

2. Tenderness, distention, muscle rigidity, and shock.

3. Casualty lies with legs pulled up, protecting the abdomen.

If the casualty has a (closed) abdominal injury, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Place casualty in the most comfortable position.

3. Carefully remove enough clothing to get a clear idea of the extent of the injuries.

4. Treat for shock.

5. Give nothing by mouth.

6. Request medical assistance immediately.

Open

Open abdominal injuries are caused by gunshots, stabbings, and penetrating wounds where the skin is broken. Always suspect that damage has occurred to internal organs, even if signs and symptoms are not immediately present. Extensive lacerations may allow some of the internal organs (Fig. 10-1) to stick out, a condition known as evisceration. Signs and symptoms of (open) abdominal injury include:

1. Signs and symptoms of (closed) abdominal injury.

2. Lacerations, puncture wounds, and vomiting blood.

3. Back pain (kidney damage).

If the casualty has an (open) abdominal injury, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABC's).

2. Carefully remove enough clothing to get a clear idea of the extent of the injuries.

3. Place casualty in the most comfortable position.

4. Treat for shock.

Figure 10-1 - Abdominal Wound with Protruding Intestines.

5. Control bleeding and apply a dry sterile dressing.

a. If organs are sticking out (protruding), do not touch or replace them. Apply a sterile compress, moistened with sterile water. If sterile water is not available, use clean drinking water. Do not use material that clings, such as paper towels, cotton, or toilet paper. Apply aluminum foil or plastic wrap over the compress keeping the area moist and warm. Hold the compress in place with a bandage, do not apply more pressure than is necessary to hold the bandage.

6. Give nothing by mouth.

7. Request medical assistance immediately.

Diabetic Emergencies

Diabetes also known as diabetes mellitus, is a disease that impairs the ability of the body to use sugar and causes sugar to appear abnormally in the urine. The two basic types of diabetes are:

Type I: Insulin-dependent (juvenile), usually begins in childhood, controlled by daily insulin injections.

Type II: Non-insulin-dependent (adult-onset), begins in adulthood, controlled by diet or oral medication. Sometimes insulin injections are required.

Diabetic Coma

Diabetic coma, also known as hyperglycemia, is a condition in which the body does not have enough insulin and has too much sugar. Causes include stress, not enough insulin injections, and eating too much sugar.

Signs and symptoms of diabetic coma include:

1. Fruity odor on breath and very thirsty.

2. Dizziness, drowsiness, and confusion.

3. Rapid, weak pulse and rapid breathing.

4. Nausea, vomiting, and abdominal pain.

If you suspect diabetic coma, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABCs).

2. Lay casualty flat, slightly elevating the head and shoulders.

3. Do not give the casualty candy or soft drinks.

4. Treat for shock.

5. Request medical assistance immediately.

Insulin Shock

Insulin shock, also known as hypoglycemia, is a condition in which the body does not have enough sugar and has too much insulin. Causes include skipping meals, too much insulin, strenuous exercise, and changes in diet.

Signs and symptoms of insulin shock include:

1. Headache, dizziness, and irritability.

2. Pale, moist skin, and excessive sweating.

3. Muscle weakness, hunger, and normal to rapid pulse.

If you suspect insulin shock, do the following:

1. Ask casualty or family member these two questions.

a. Has the casualty eaten today?

b. Has the casualty taken his or her insulin?

If the answer is "yes" to the first question and "no" to the second, the casualty is probably in a diabetic coma.

2. Establish and maintain the airway, breathing, and circulation (ABC's).

3. Lay casualty flat, slightly elevating the head and shoulders.

4. Give the conscious casualty candy or soft drinks to increase blood sugar level.

5. Treat for shock

6. Request medical assistance immediately.

Stroke

Stroke, also known as cerebrovascular accident, is a condition in which one or more of the blood vessels to the brain become blocked or rupture, causing part of the brain to die from lack of oxygen. Causes include arteries blocked by a clot (thrombus), ruptured blood vessels (hemorrhage) in the brain, or a clot that travels (embolus) to the brain from another part of the body.

Signs and symptoms of stroke include:

1. Onset is sudden, with little or no warning.

2. Weakness or paralysis of one side of the body.

3. Loss of facial expression and drooping mouth on one side.

4. Double vision, stuttering, and severe headache.

5. Difficulty speaking, and understanding speech.

6. Unequal pupils, nausea, and vomiting.

If you suspect a stroke, do the following:

1. Lay casualty flat, slightly elevating the head and shoulders.

2. Establish and maintain the airway, breathing, and circulation (ABCs).

3. Keep the casualty quiet and warm.

4. Give nothing by mouth.

5. Request medical assistance immediately.

Heart Attack

Heart attack, also known as myocardial infarction, is a condition in which blood flow to part of the heart is blocked, causing that part of the heart muscle to die from lack of oxygen. Most heart attacks are caused by cardiovascular disease. Risk factors are things that are related to getting cardiovascular disease. Casualties may deny that they are having a heart attack. Suspect heart attack in adults with chest pain until proven otherwise.

1. Risk factors that you cannot change:

a. Heredity (family history of cardiovascular disease)

b. Sex (males have a greater risk)

c. Age

2. Risk factors that you can change:

a. Smoking

b. High blood pressure

c. High blood cholesterol

d. Obesity

e. Lack of exercise

f. Stress

g. Uncontrolled diabetes

Signs and symptoms of a heart attack include:

1. Severe, under the breastbone (substernal) chest pain (crushing, squeezing, or like somebody is standing on my chest).

2. May spread to the jaw, shoulders, arms, neck, or back.

3. Difficulty breathing.

4. Pale, moist skin, and excessive sweating.

5. Anxiety, nausea, and vomiting.

6. Weakness and lightheaded.

If you suspect a heart attack, do the following:

1. Establish and maintain the airway, breathing, and circulation (ABCs).

2. Place the casualty in the most comfortable (sitting or semi- sitting) position.

3. Keep the casualty quiet, and warm.

4. Loosen restrictive clothing, at the neck, waist, and chest.

5. Be prepared to give CPR (Chapter 2).

6. Request medical assistance immediately.

Seizures

Seizures, also known as convulsions, are a twisting of the body caused by violent, involuntary muscle contractions. Causes include epilepsy, head injury, infection, disease, and fever. The casualty will be drowsy and disoriented after the seizure.

Signs and symptoms of a seizure include:

1. A sensation or feeling (aura) usually visual, sound, taste, or smell).

2. Crying out or moan from casualty.

3. Partial or total loss of consciousness and muscle rigidity.

4. Jerking (spasm) of the arms and legs.

5. Frothing from the mouth.

6. Possible loss of bowel and bladder function.

If the casualty has a seizure, do the following:

1. Lay the casualty flat, protecting him or her from injury.

2. Move all objects out of the way to prevent further injuries.

3. Don't force anything between the teeth or restrain the casualty in any way.

4. Loosen restrictive clothing, at the neck, waist, and chest.

5. Calm and reassure the casualty.

6. Establish and maintain the airway, breathing, and circulation (ABC's).

7. Give nothing by mouth.

8. Request medical assistance immediately.

Alcohol Intoxication

Alcohol is the most widely used and abused drug today. Alcohol intoxication, also known as drunkenness, is so common that it fails to receive the attention and respect it deserves. Ethyl alcohol (ethanol), is the primary ingredient in wine, beer, and liquor. Ethanol is classified as a drug because it depresses the central nervous system, affecting physical and mental activities. Alcohol is addictive. What starts out as social drinking may, and frequently does, result in alcoholism.

Alcohol affects the body in stages. First, there is a feeling of relaxation and well-being, followed by a gradual disruption of coordination, resulting in an inability to accurately and efficiently perform normal duties and activities. Continued drinking depresses body functions enough to cause difficulty breathing, loss of consciousness, coma, and death. Withdrawal from alcohol can result in delirium tremens (DTs), identified by anxiety, confusion, restless sleep, nausea, vomiting, depression, hallucinations, and seizures. If you choose to drink, do so in moderation. If you can't control your drinking, get help before it's too late.

Signs and symptoms of alcohol intoxication include:

1. Smell of alcohol on breath.

2. Staggering, loss of balance, and slurred speech.

3. Nausea, vomiting, and flushed face.

These signs and symptoms may indicate an illness or injury (e.g. diabetes, head injury) other than alcohol abuse. If you suspect alcohol intoxication, do the following:

1. Sit or lay the casualty down, protecting him or her from further injury.

2. Establish and maintain the airway, breathing, and circulation (ABCs).

3. Perform an initial assessment.

4. Observe closely, casualty may become unconscious.

5. Don't criticize, be firm with casualty.

6. Never leave an intoxicated casualty alone.

7. Request medical assistance as soon as possible.

Psychiatric Emergencies

A psychiatric emergency is a sudden onset of behavioral or emotional responses that, if not responded to, may result in a life-threatening situation. Probably the most common is the suicide attempt. This may range from verbal threats and suicide gestures to successful suicide. Always assume that a suicide threat is real, do not leave the individual alone. In all cases, the main consideration is to keep them from inflicting harm to themselves and getting them under the care of a medical professional.

Drowning

Drowning is suffocation by immersion in water or other liquid. Causes include diving accidents, drinking alcohol prior to or during swimming, getting trapped under the water, and becoming exhausted while swimming. Fluid rarely enters the lungs because upon contact with fluid, spasms of the windpipe occur which seal the airway from the mouth and nose.

If a drowning has occurred, do the following:

1. Reach the casualty without putting yourself in danger.

2. Establish and maintain the airway, begin mouth-to-mouth or mouth-to-nose breathing while in the water.

3. Don't remove the casualty from the water until a backboard or other rigid devise is available.

4. Maintain a neutral position of the head and neck, apply a cervical collar or improvised (towel) collar.

5. Be prepared to give CPR (Chapter 2).

After removal from the water.

6. Keep the casualty warm enough to maintain normal body temperature.

7. Request medical assistance immediately.

An apparently lifeless casualty who has been in cold water for a long period of time may still be revived with rescue breathing. The body reduces the need for oxygen and protects the vital organs in water below 68 degrees F.

Electric Shock

Electric shock is the effect produced by the passage of an electric current through any part of the body. Causes include contact with a "live" wire or circuit, and occasionally occur when a person is struck by lightning. Fundamentally, electrical current rather than voltage is the criterion of shock intensity. The passage of even a very small current through a vital part of the body can cause death. The voltage necessary to produce the fatal current is dependent upon the resistance of the body, contact conditions, and the path through the body.

Signs and symptoms of electric shock include:

1. Skin pale or even bluish (cyanotic).

2. Pulse weak or absent.

3. Burns and unconsciousness.

4. Breathing is shallow or absent.

5. Body may become rigid or stiff due to the muscular reaction to the shock, don't consider this to be rigor mortis. The appearance of rigor mortis shall not be assepted as a positive sign of death.

If you suspect electrical shock, do the following:

1. Shut off the power. If you cannot shut off the power, remove the victim immediately. Stand on a well-insulated object and use a dry rope, wooden pole, or other non-conductive material to either push or pull the wire away from the casualty, or the casualty away from the electrical source. Do not attempt to administer first aid or come in physical contact with an electrical shock casualty before shutting off the power. If you cannot shut off the power immediately, remove the victim from the live conductor before touching them.

2. Maintain neutral position of the head and neck, apply a cervical collar or improvised (towel) collar. (Casualty is usually thrown).

3. Establish and maintain the airway, breathing, and circulation (ABCs).

4. Perform an initial assessment.

5. Begin CPR/rescue breathing if necessary (Chapter 2) and continue until successful.

6. Cover burn areas (Chapter 7) with a moist, preferably sterile dressing.

7. Treat for shock. (Chapter 4)

8. Request medical assistance for all electrical injuries. If possible, before transport, inform medical personnel of the electrical source involved and the location of the entrance and exit wounds.

References

1. Karren, K. J., and Hafen, B. Q. :First Responder A Skills Approach, ed. 3, Norton Publishing Company

2. NAVEDTRA 10669-C, Hospital Corpsman 3 & 2

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Washington, DC 20372-5300

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Operational Medicine 2001
Health Care in Military Settings

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