3-31
Melatonin helps restore abnormal circadian rhythms resulting from shift work or jet lag.
Primitive: Sunglasses that block UA/UVB; blackout curtains in sleeping quarters
Snoring and/or Obstructive Sleep Apnea
Primary: Over-the-counter decongestants
Alternate: Flonase 1-2 sprays each nostril q hs
Primitive: Use a sleep wedge to prevent sleeping on the back
Depression (See Symptom: Depression)
Primary: (See Mental Health chapter); serotonin specific re-uptake inhibitor (SSRI), such as Prozac
Alternate: Different SSRIs such as Zoloft. Paxil or tri-cyclic antidepressants should be avoided as these
often have the side effect of fatigue!
Patient Education
General: Symptom reduction- help the patient to learn to cope with their symptoms and maintain their highest
possible functioning level. This requires a good medic-patient alliance and a mutual understanding of the
diagnosis and treatment goals.
Follow-Up: Follow patient on a routine schedule to assess for improvement of symptoms with treatment
interventions. Change therapy if symptoms continue. NOTE: The symptom reduction in depression may take
4-6 weeks; therefore, until the patient has taken therapeutic doses of a drug for at least 2 months, therapy
should not be discontinued.
Evacuation/Consultation Criteria: Acute evacuation is not usually necessary, unless the patient is unstable
or non-mission capable. If labs remain unrevealing and the patient has persistent symptoms of fatigue for
greater than 6 months, then a diagnosis of chronic fatigue may be entertained and the patient referred. Note
that chronic fatigue is NOT the same as chronic fatigue syndrome, which has specic diagnostic criteria.
Symptom: Fever
COL Naomi Aronson, MC, USAIntroduction: Low-grade fevers are non-specific, commonly of viral etiology, generally do not have a large
impact on morbidity and mortality in adults and will not be addressed here. Significant fever (oral temperature
101°F in an adult) is a common symptom of infectious disease, but it can be seen with other conditions
such as malignancy, heat-related illness, drug reactions, rheumatologic conditions, or hyperthyroidism. Travel
history is very important because infectious disease patterns are dynamic. The Armed Forces Medical Intel-
ligence Center (AFMIC) and electronic networks such as PROMED and MEDIC should be consulted to identify
diseases occurring specific areas, current outbreaks and emerging disease patterns.
Several principles apply to the initial approach of a febrile patient:
· Assess first for infections that can be quickly life-threatening (the duration of fever, place and type of
exposure, related clinical symptoms can be helpful in further directing you).
· Avoid delays in starting empiric broad-spectrum treatment for most possible infections in ill-appearing
patients.
· Treat fever in the tropics or in a traveler from the tropics as malaria until proven otherwise.
· Remember to consider infections that are contagious and/or have public health implications
· Intravenous fluids (normal saline or Lactated Ringer’s solution) are recommended for hypotensive
febrile patients.
Subjective: Symptoms
Fever > 101°F
Incubation period of febrile diseases:
Acute (1-14 days): Malaria, pneumonia, arboviruses, hemorrhagic fevers, diarrhea illness, UTI, rickettsial
infections, leptospirosis, measles
Sub acute (15-30 days): Hepatitis, HIV, CMV, typhoid fever, schistosomiasis, mononucleosis, rabies, rubella,