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.