Special Operations Forces Medical Handbook

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peroxidase, and may exacerbate simple goiter and induce hypothyroidism.
Pregnancy: Normal pregnancy results in mild symptoms that can be confused with hyperthyroidism. Severe
symptoms suggest the presence of hyperthyroidism in pregnancy and expedient consultation is required if at
all possible. Slight enlargement of the thyroid gland is expected in normal pregnancy.
Thyroid Storm: Most cases of hyperthyroidism are not emergencies, but the medic should be alert to the
possibility of the syndrome of thyroid storm. Thyroid storm is a symptom constellation including fever, delirium
(or confusion, also known as encephalopathy), very marked tachycardia, and a generally “toxic” appearance.
Individuals with these features require emergent evacuation to a skilled medical facility. Interim treatment
in the eld should include beta-blocker medication (propranolol), antipyretic therapy with acetaminophen
(theoretically, aspirin may worsen the condition by releasing thyroid hormone from binding sites on plasma
proteins) and/or ice packs, and sedation using benzodiazepines or haloperidol.
.

Chapter 5: Neurologic

Neurologic: Seizure Disorders and Epilepsy

CDR Robert Wall, MC, USN

Introduction: A seizure is an uncommon event that can be caused by many different ailments and processes.

Not all convulsions become an epileptic condition, and most are brief and self-limited. Once a “diagnosis” of

epilepsy is documented, it will follow the patient for the rest of their life and greatly impact their employability,

insurability, driving status and many other areas.

Subjective: Symptoms
Abrupt onset of abnormal muscle activity, or prodrome of confusion, déjà vu, peculiar behavior, automatisms, or
other psychic phenomena preceding onset.

Objective: Signs

Using Basic Tools: Sudden onset of loss of consciousness, followed by abnormal motor activity such as tonic

rigidity, clonic rhythmic movements of the limbs, urinary incontinence, frothing at the mouth, and biting the tongue

and mouth; may last seconds to minutes, and is usually followed by a period of weakness, somnolence and

confusion (post-ictal state); will spontaneously stop without any intervention after a few minutes.

Using Advanced Tools: Lab: WBC for infection; urinalysis for glucose level; EKG for arrhythmia etiology

for syncope.

Assessment:

Differential Diagnosis - the differential diagnosis of a convulsive event is extensive: idiopathic epilepsy,

alcohol or drug associated seizures, post concussive syndrome, convulsive syncope, heat stroke, infectious

(meningitis), brain mass lesions, nerve gas exposure and metabolic abnormalities. See index and appropriate

sections of this book for discussions of most of these conditions.

Plan:

Treatment: Many of these medications and procedures may not be available in the eld.

Primary: Symptomatic treatment initially.

1. Remove the patient from an area where he could injure himself or others. Keep sharp and breakable objects
   away from the patient. Pad objects if possible to avoid injury.


2. Do not put anything in the patient’s mouth. Never put your ngers in the patient’s mouth.


3. MEDICATIONS ARE RARELY INDICATED FOR A FIRST TIME SEIZURE.


4. After the seizure, evacuate the patient to an appropriate treatment facility for a neurological examination and
   further evaluation.
   The exam will usually be normal, other than confusion and somnolence in the immediate post-ictal period, which
   may last for hours. After focal motor seizures, there may be a period of Todd’s Paralysis, which is focal weakness