3-87
Follow-up Actions
Return evaluation: If traumatic head injury occurred and symptoms worsen over days, suspect a slow
intracranial bleed. Medically evacuate ASAP. Repeat funduscopic exams to look for papilledema (an indication
of increased intracranial pressure) on follow up exams.
Evacuation/Consultation Criteria: Evacuate if patient unable to function, if unstable or if deteriorates.
Consult psychiatry or neurology if needed.
NOTE: Denitive diagnosis may require lumbar puncture, neuroimaging, EEG or use of specialty consultation.
Symptom: OB Problems: Pregnancy
MAJ Marvin Williams, MC, USASubjective: Symptoms
In women with regular menstrual cycles, a history of one or more missed cycles (periods) is suggestive
of pregnancy. Associated symptoms include fatigue, nausea/vomiting, breast tenderness, frequent urination
(caused by the enlarged uterus compressing the bladder), and “quickening” (first movements of a fetus felt in
utero at 16-20 weeks). Calculate the EDC (estimated date of confinement) by adding 7 days to the first day of
the last normal menses and subtracting 3 months.
Objective: Signs
Spider angiomata (branched capillaries on the skin, shaped like a spider) and blotchy or patchy palmar
erythema (more than 50-60% of patients), regress after delivery.
Striae gravidarum (stretch marks) develop in 50% of pregnant woman.
Hyperpigmentation of nipples, areola, umbilicus, axillae, perineum and midline of lower abdomen (linea nigra).
Breast enlargement due to increased hormone levels, which later causes release of colostrum (thin, yellowish
fluid seeping from the nipple) and lactation.
Other common signs and symptoms include lightheadedness, backache, dyspnea, urinary symptoms
(frequency, urgency, and incontinence), hemorrhoids, heartburn, ankle swelling, varicose veins, abdominal
cramping and constipation.
Using Basic Tools: Fetal heart tones can be heard via auscultation (bell side of stethoscope) at or beyond
18-20 weeks of gestation.
Using Advanced Tools: Pregnancy tests can be used in the field. Most are nearly as accurate (97-99%)
as a laboratory test on serum.
Assessment:
Palpation of fetal parts and the appreciation of fetal movement and heart tones are diagnostic.
Plan:
Treatment: See appropriate sections in this chapter.
Symptom: OB Problems: Vaginal Delivery
MAJ Marvin Williams, MC, USAWhen:
Labor is defined as progressive dilation of the uterine cervix in association with repetitive uterine contractions
resulting in complete dilation (10 cm) and effacement (thinning) of the cervical os. Normal labor is a
continuous process.
First stage: Onset of cervical changes and uterine contractions through full dilation and effacement of cervix
Second Stage: Full cervical dilation and delivery of the infant
Third Stage: Interval between the delivery of the infant and delivery of the placenta