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Treatment
Pulmonary:
Asthma, COPD, Pneumonia: See respective sections in Respiratory chapter.
Atelectasis: Oxygen (O 2 ); systematic chest percussion may loosen mucus plug
Pneumothorax/Tension pneumothorax/hemothorax: O 2 ; needle thoracotomy; address underlying condition;
place chest tube (see Procedure: Chest tube and Needle Thoracotomy)
Pleural effusion: O 2 ; needle thoracentesis to drain pleural effusion; address underlying illness
Airway obstruction: Provide O 2 in all these cases; be prepared to perform emergency surgical airway
(cricothyroidotomy) if patient becomes cyanotic or excessively dyspneic or tachypneic
Epiglottitis/Edema of glottis – Antibiotics (cefuroxime 1 gm IV q 8 h, or cefotaxime 2 gm IV q 4-8 h);
do not attempt intubation
Tumor – May require intubation, nasal airway or emergency airway (tumor location may inuence choice
of airway)
Retropharyngeal abscess/hematoma – Intubate or try nasal airway if possible; do NOT drain abscess or
hematoma; antibiotics (cefuroxime 1 gm IV q 8 h, or cefotaxime 2 gm IV q 4-8 h)
Foreign object – Remove if possible (Heimlich Maneuver or sweep/grasp object); do NOT intubate with
object in airway
Neck Trauma – Intubation or nasal airway if possible after check for foreign bodies in airway
Cardiac: Provide O 2 in all these cases
MI, CHF, pulmonary embolism: see appropriate sections
Tamponade: see Cardiac: Pericarditis.
Valvular malfunctions - follow Fluid Resuscitation section guidelines as needed to maintain stable vital signs;
follow CHF section treatment guidelines to mobilize fluid in pulmonary and peripheral edema
Chemical: Diabetes (see Endocrine: Diabetes)
Central Nervous System: Include: Narcotics, stroke or head trauma.
Drug induced: May require intubation; O 2 , dextrose 50 IV, fluid resuscitation, Narcan or other agent-specific
antidote (if known, if available); supportive care
Stroke/Cerebral hemorrhage/trauma: O 2 ; intubate, Foley catheter, dextrose 50 IV, fluid resuscitation and
protective restraints if unconscious; bedrest if conscious
Psychogenic: Have patient breathe into a bag (will reverse myoclonic spasms in 10-15 minutes). Rule out
underlying medical condition. Treat anxiety with an anxiolytic (Valium, 10 mg IV/IM), or alcohol.
Patient Education
General: Remain calm. Anxiety will worsen the symptoms.
Follow-up Actions
Evacuation/Consultant Criteria: Most of these patients will require evacuation for denitive treatment and
advanced procedures. Evacuate when stable and capable of travel.
Symptom: Syncope (Fainting)
CAPT Kurt Strosahl, MC, USN & CPT Brooks Morelock, MC, USAIntroduction: Syncope (fainting) is the sudden, unexplained loss of consciousness with loss of motor tone.
Most causes are cardiac or neurologic in nature and include: hypoperfusion of the brain caused by blood
pooling in the lower extremities (neurocardiac or vasovagal); decreased intravascular volume (blood loss,
adrenal insufficiency); seizure; autonomic dysfunction in Shy-Drager syndrome or recurrent heat exhaustion;
tachycardia (>180) or bradycardia (<40); hypoglycemia or psychological disorders. Malignant arrhythmia (e.g.,
ventricular fibrillation) is one of the most worrisome causes of syncope and can be life threatening.
Subjective: Symptoms
Sudden, unexplained loss of consciousness possibly preceded by light-headedness, nausea, sweating,
sudden fatigue, hunger or “seeing stars.”