Special Operations Forces Medical Handbook

3-2

Plan:
Treatment
Goals for Field Management: Eliminate pain, maintain intravascular volume and treat infection.

1. Place 1 large IV (>18 gauge). If hypotensive or bleeding then place 2 IVs.


2. Use D5Lactated Ringer’s or normal saline at 100 cc/hr or boluses of 500 cc to normalize blood pressure
   and resuscitate.


3. Insert NG tube for gastric decompression for signicant abdominal distention or vomiting.


4. Use pain control medications (see Procedure: Pain Assessment and Control).


5. Use antiemetic of choice (e.g., Compazine 5-10 mg IM q 3-4 hr, max 40mg/day).


6. Acid suppression: Pepcid 20mg per NG tube q 6 hrs, or Pepcid 20mg (10mg/ml) IV over 2 minutes
   q 12 hrs.


7. If fever and/or peritoneal signs present, then initiate antibiotics:
   Single Agents: Cefoxitin 2 gm IV q 8 hr, cefotetan 2 gm IV q 12 hr, cefmetazole 2 gm IV q 8-12 hr
   Combination Agents: Aztreonam 2 gm q 8 hr plus metronidazole 500 mg IV q 8 hr


8. Evacuate for potential surgery if any of the following: persistent or worsening abdominal pain with duration

   
   

   4 hours, associated fever, signs of hypovolemia, intestinal bleeding, shock or peritonitis.

   
   

   
   

Patient Education
General: Maintain healthy diet with high ber, low fat content. Exercise daily.

Follow-up Actions
Evacuation/Consultant Criteria: Evacuate urgently for continuing pain or unstable condition. Consult
general surgery early and other appropriate specialties as needed.

Symptom: Anxiety

MAJ Michael Doyle, MC, USA

Introduction: Anxiety is a vague feeling of apprehension due to the anticipation of danger. It is a common,
normal reaction to any internal or external threat, is usually transient and does not tend to recur frequently.
Some situations—like jumping out of an airplane—are inherently anxiety provoking. When the symptoms of
anxiety begin to interfere with duty or with social/occupational functioning, the medic may need to intervene.
Anxiety, as a symptom, is often associated with most mental disorders and Combat and Operational Stress
Reactions. This section identies those specic conditions in which anxiety is the disorder and not just a
symptom of a condition.

Subjective: Symptoms
Free-oating anxiety not attached to any particular idea or notion, fear, agitation, tension, panic. Patients may
then complain of sleep, appetite or activity disturbances.
Focused History: When did you start feeling this way? Have you ever felt this way before? (identify
precipitating events) Are these feelings constant or do they come and go? How long do the spells last?
(Panic attacks come and go and are usually brief; anxiety due to an underlying medical condition or from post
traumatic stress disorder (PTSD) or other chronic anxiety conditions usually is present always.) Does the
anxiety keep you from sleeping or wake you up? How is your appetite? (If there are signicant appetite and
sleep problems, then a mood disorder may be the culprit.) Can you do your job? (Occupational impairment
is important to document and monitor.) Do you have thoughts of hurting yourself or anyone else? (always
consider safety) What helps you feel better? (incorporate the patient in treatment plans)

Objective: Signs
Using Basic Tools: Distracted, jittery, skittish, easily startled and often confused.

Mini Mental Status A-

Alert and oriented in all spheres; may appear easily distracted or startled
Activity—restless, hypervigilant, easily startled
Speech—may be rapid, breathless, but also can be slowed with hesitancy or stutterin