Special Operations Forces Medical Handbook

3-13

Return evaluation: Repeat EKG and other pertinent exams.
Evacuation/Consultation Criteria: All life threatening causes should be evacuated at the first window of
opportunity for further evaluation and treatment. Recurrent chest pain without objective findings may be
treated with aspirin and diazepam but should be further evaluated upon completion of the mission.

Symptom: Constipation

COL (Ret) Peter McNally, MC, USA

Introduction: Constipation is a conscious, unpleasant, and subjective sensation of deviating from the
“normal” defecation pattern. Most will feel uncomfortably distended and “backed up.” Healthy and active
persons may become acutely constipated after a change in lifestyle, decrease in dietary bulk, dehydration or
inactivity. When the urge to defecate is repeatedly repressed or ignored, constipation may arise.

Subjective: Symptoms
The denition of constipation varies person to person but a reasonable denition is as follows: Two or fewer
bowel movements per week, straining > 25% of the time, hard stools > 25% of the time, incomplete evacuation

25% of the time. Constipation is much more common among women than men, and the young and
aged persons are especially prone. Common causes of constipation include inadequate ber & food intake,
repression or ignoring the urge to defecate, and immobility. Medications such as opiates, anticholinergics
and antidepressants can slow intestinal transit and promote constipation. A preceding history of prolonged
connement in a vehicle, airplane or ship with inactivity and decreased intake is typical.

Objective: Signs
Uncomfortable and restless; normal vital signs; distended abdomen; stool-lled loops may be palpable but
abdominal tenderness is uncommon. Always look for signs of hypothyroidism: fatigue, feeling cold, loss of
hair.

Assessment:
For acute constipation temporally associated with change in diet and activity, no testing is necessary. For
chronic constipation, tests to exclude structural and systemic disease are necessary.

Plan:
Treatment
Primary: Laxative: senna bisacodyl, single to few doses (onset <24 hr).
Alternate: Magnesium citrate 12 oz po (effective in 6-8 hrs); psyllium or methylcellulose, daily dosing with
increased uid intake (effect within a week).
Primitive: Perform a digital rectal examination and remove fecal impaction if present. If hard stool is present,
glycerin or bisacodyl suppositories may be helpful. Position the suppository against the rectal wall.

Patient Education
General: Promote healthy, high ber diet, increased uid consumption and daily exercise. Answer the urge
to defecate. Develop a regular bowel habit.

Follow-up Actions
Evacuation/Consultation Criteria: Evacuation is not usually necessary. Consult as needed.

Symptom: Cough

COL Warren Whitlock, MC, USA

Introduction: Cough is a normal physiologic function of the respiratory system, and is the only mechanism
that clears secretions from the lung. Conditions that cause coughing include respiratory obstruction from
increased secretions or aspirating foreign material, irritation (infectious, chemical or thermal injury), chronic