Special Operations Forces Medical Handbook

3-115

4. Relieve itching.
   a. Sarna lotion (camphor and menthol) and cool compresses can relieve itch for short periods of an
   hour or so.
   b. Avoid extensive applications of topical steroids when the etiology of pruritus is unclear.
   c. Antihistamines like Atarax 25-50 mg po q hs or antidepressants like Doxepin (75 mg po q hs) can be
   helpful at bedtime, but tend to cause drowsiness, so use with caution.
   d. Ultraviolet Sunlight (UVB or PUVA) can help. Avoid midday sun with burning infrared rays.
   e. Anxiety and stress, as well as depression can elicit or worsen pruritus. Psychiatric consultation may be
   helpful, but work hard to get the patient’s confidence before even suggesting this.

Patient Education
General: Do not use water to moisten skin. It causes further drying. Take medication as indicated. Do not
scratch.
Prevention: Keep skin moist during winter by avoiding hot water, excessive washing, harsh soap.

Follow-up Action
Evacuation/Consultant Criteria: Evacuation is not normally necessary. Consult dermatology as needed.
NOTE: Skin biopsy by dermatologist is sometimes necessary for accurate diagnosis.

Symptom: Shortness of Breath (Dyspnea)

COL Warren Whitlock, MC, USA

Introduction: Dyspnea or “shortness-of-breath” is an uncomfortable sensation of difficulty in breathing. It
is a symptom, for which the sign may be a rapid respiratory rate. There are several types (see below).
Stridor is a physical finding (usually loud enough to be heard at some distance) associated with upper airway
obstruction and is a reason for medical concern.

Subjective: Symptoms
Focused History: Exposure History: Affirmative answers to any of the following place patient at risk for
dyspnea. Have you had trauma to head, neck or chest? Have you been flying or diving recently? (decompres-
sion sickness) Did the symptoms start while you were eating or holding something in your mouth? Do you
smoke? (risk for COPD, tension pneumothorax, MI) Are you taking any medicines or drugs?
Past Medical History: Affirmative answers to any of the following place patient at risk for dyspnea. Have
you ever had heart problems, diabetes, vascular disease, asthma, COPD? If so, did you fail to take your
medications? Have you ever had any mental health problems, including suicide attempts? (anxiety, drug
abuse) Have you had a recent respiratory illness?
Specific Symptoms: Have you had chest pain? (MI, trauma, occasionally pulmonary embolus) or radiating
pain? (MI, aneurysm) or fever? (pneumonia, sometimes pulmonary embolus) or cough? (pneumonia [produc-
tive]; pulmonary embolus, CHF, COPD, asthma [may be productive]) or difficulty breathing at night? (MI,
CHF) or trouble swallowing? (oropharyngeal obstruction due to foreign body, tumor, glottic edema, epiglottitis,
retropharyngeal mass) or weight loss? (tumor, COPD, drug abusers) or loss of control of muscles or feeling
in part of your body? (stroke, brain tumor, drugs) or muscle spasms? (possible psychogenic etiology)
Onset: Did the symptoms start suddenly? (foreign object, pneumothorax, MI, stroke, epiglottitis, pulmonary
embolus, drug abuse) or progressively worsen over hours to days? (cardiac tamponade, pericardial effusion,
COPD, asthma, diabetes, pleural effusion due to inflammatory process, aneurysm)

Objective: Signs
Using Basic Tools:
Vital Signs: Pulse: Tachycardia except if drug or Central Nervous System (CVA, tumor) related, and in MI.
Respiration: Tachypnea EXCEPT POSSIBLY in Central Nervous System or drug-related dyspnea.
Blood Pressure: Hypotension: cardiac cause, pulmonary embolus. Hypertension: other causes, but especially
chronic vascular disease-related dyspnea or in psychogenic dyspnea. Either: CVA, brain tumor, drugs.
Decreased pulse pressure seen with cardiac tamponade