4-8
What Not To Do:
Do not initiate CPR on an obviously dead patient.
Do not initiate CPR under direct enemy fire. A patient in cardiopulmonary arrest during a firefight is dead.
Do not touch the patient while AED is analyzing the cardiac rhythm.
Do not use the ‘Analyze’ function on an AED while in a moving ground vehicle or during moderate/heavy
turbulence if in an aircraft.
Do not leave your patient alone. Patients with acute myocardial infarctions can go into a malignant arrhythmia
(frequently V-Tach or V-Fib) with no warning.
Do not assume that a ‘normal’ EKG rules out heart disease as a cause of chest pain.
-Do not assume that all ‘heartburn’ pain is due to indigestion. In particular, do not assume that eliminating
chest pain by administering a ‘GI Cocktail’ rules out cardiac origin chest pain.
-Do not withhold aspirin if there is a chance of cardiac chest pain. Most people can tolerate a single dose
of aspirin without difficulty. Exceptions are cases of true aspirin allergy, asthma with aspirin sensitivity, and
active ulcer, GI bleeding or hemorrhagic stroke.
Resuscitation Algorithms
Cardiac resuscitation algorithms have been developed by the American Heart Association, but could not be
reprinted here for copyright reasons.
Chapter 2: Blood
COL Richard Tenglin, MC, USABlood is made up of solid (cellular) and liquid (plasma) components. Cellular elements originate from bone
marrow, and may be broken down as follows: white blood cells (WBCs) that fight infection, red blood cells
(RBCs) that transport oxygen and platelets that stop bleeding. Symptoms result due to low numbers of cells or
deficient cell function (which paradoxically may occur with increased numbers of abnormal cells, such as with
leukemia), or when cell numbers build up to such a point that they obstruct blood flow. Low cell numbers
are caused by decreased production, or increased loss (bleeding), consumption or destruction. Plasma
contains the soluble coagulation factors, immunoglobulins, electrolytes, protein and water. Evaluation of blood
disorders often requires performing a spun hematocrit and a Wright (Cameco Quick Stain) stained peripheral
smear (see Lab Procedures Section).
Anemia
Introduction: Anemia refers to an abnormally low amount of the oxygen-carrying protein hemoglobin (may
also have low number or volume of red cells) in peripheral blood. “Hematocrit” is the percent volume of whole
blood occupied by the red cells, and is determined by spinning a sample of blood and measuring the volume
of the “packed” red cells divided by the total volume of the sample. It is a rough measure of the amount
of oxygen-carrying protein (hemoglobin) in the sample, but is subject to many problems with technique that
can lead to numbers that do not reflect the true hemoglobin content of blood. Modern Coulter Counters used
in clinical labs actually measure the amount of hemoglobin, and calculate, but do not actually measure, the
hematocrit. The SOF medic will actually measure the hematocrit, but must be aware that some diseases, or
bad technique (not spinning the sample sufficiently) will give results that do not reflect the actual hemoglobin
content of the patient’s blood. Anemia may be acute (traumatic blood loss) or chronic (due to chronic disease),
and results from either increased loss/destruction of red cells or failure of the bone marrow to produce
sufficient quantities of hemoglobin/red cells to make up for normal red cell loss. Anemia can be determined by
a spun hematocrit. The procedure for obtaining a hematocrit and “normal” values are specific to the machine
used. Normal hemoglobin levels differ among ethnic populations and between men and women, with males
and whites averaging higher values. Worldwide, the most common cause of acquired anemia is iron deficiency
due to chronic blood loss from hookworm and menstruation. Other important causes are lack of important
nutrients (protein, Vitamin B12, Folic Acid) and suppression of the bone marrow from chronic infection or
inflammation. The causes of anemia are extensive and beyond the ability of the medic to accurately diagnose