5-147
Follow-up Actions
Return evaluation: If antivenin has already been given, give more. Administering an inadequate amount of
antivenin is a common mistake. Watch closely for sudden anaphylactic shock.
Evacuation/Consultation Criteria: Evacuate snakebite victims for intensive care if possible. Consult with
emergency medicine physician if available.
NOTES: Snake identification–Pit vipers: “pit” located below each nostril; triangular-shaped head; elliptical,
not round, pupils; hollow fangs; single, not double row of scales on the ventral (belly) side distal to the anal
plate; rattlesnakes usually have a rattle.
Coral snakes in U.S. - encircling colored bands of black, red and yellow/white, with the latter bands touching
(“red on yellow, kill a fellow; red on black, venom lack”); no long fangs; small mouth makes it difficult for
them to bite anything larger than finger.
Chapter 18: Mental Health
Anxiety Disorders: See Symptom: AnxietyMental Health: Operational Stress
MAJ Michael Doyle, MC, USAIntroduction: Battle fatigue is a normal response to the abnormal stress of combat, and is the term applied to
any combat-related stress reaction requiring treatment. Combat and Operational Stress Reaction is the term
applied to service members who present psychologically or emotionally disturbed in non-combat situations.
Most service members presenting with signs and symptoms of an emotional or psychological disturbance do
not have a mental disorder, but rather, are struggling with the abnormal stress of military operations. Sorting
those from the relatively small number that have actual mental disorders is a process called Neuropsychiatric
Triage. In a deployed/operational setting, service members who present for evaluation of emotional or
psychological symptoms (or are brought in by the chain of command) do so because of an impairment in
duty performance, concerns for safety, or both. Always think SAFETY. Have the chain-of-command secure
the service member’s weapon and send the service member with an escort if there is any concern for safety.
Battle Fatigue is classified as either Light or Heavy. This classification guides treatment planning depending
on the tactical situation as well as the severity of symptoms. Light: minimal to mild impairment in functioning;
symptoms are present but do not significantly impact duty performance; duty performance complaints are more
subjective than objective. Tactical situation allows for forward treatment. Heavy: obvious impairment in duty
performance or tactical situation precludes treatment at unit or forward aid station.
Subjective: Symptoms
Anxiety, nervousness, fear, panic, terror, sadness, guilt, depression, anger, insomnia, hallucinations, delu-
sions, hyper-alertness, agitation, inattention, carelessness, erratic actions, outbursts, or physical exhaustion,
immobility, panic running, loss of skills, or loss of memory; loss of confidence, hope, or faith; somatic
complaints: muteness, blindness, deafness, paralysis or weakness; thoughts of hurting oneself or someone
else.
Focused History: How long have you had these feelings? (longer than few days suggest mental disorder)
Can you fight? Can you do your job? (ask the same of a supervisor – Light Battle Fatigue if affirmative) Do
you have any thoughts of wanting to hurt yourself of anyone else? Have you ever had those thoughts in the
past? (Always ask - suggests instability and a danger to the unit)
Objective: Signs
Using Basic Tools: Usually none; tachycardia. Repeat the exam to ensure nothing was missed.
Assessment:
Differential Diagnosis: Undetected physical trauma - Always be concerned with a hidden injury missed