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91W10
Advanced Individual
Training Course

Clinical Handbook
Supportive Care

Department of the Army
Academy of Health Sciences
Fort Sam Houston, Texas 78234

Academy of Health Sciences
91W10
Field Training Workbook - Index

i
Treat Metabolic Endocrine Symptoms\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.1-7
\ue000
Review of principles of glucose metabolism
\ue000
Assess the casualty for hypoglycemia and hyperglycemia
\ue000
Disorders of the Thyroid Gland
\ue000
Hypothyroidism
Treat Neurological Symptoms\u2026\u2026\u2026\u2026\u2026\u2026..\u2026\u2026\u2026\u2026\u2026.\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u20268-20
\ue000
Determine the cause and/or mechanism of injury
\ue000
Assess a casualty in a field setting using the Glasgow Coma Scale
\ue000
Assess a patient with neurological symptoms in a clinical setting
\ue000
Assessment of Patient with Specific Neurological Symptoms
\ue000
Refer to further medical care
Treat Cardiopulmonary Symptoms\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026.\u2026.21-31
\ue000
Assess Cardiac Compromise
\ue000
Provide Care for Cardiac Compromise
\ue000
Assess Respiratory Symptoms
\ue000
Provide Care for Respiratory Illness
Treat Gastrointestinal Symptoms\u2026\u2026\u2026\u2026..\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\u202632-43
\ue000
General assessment
\ue000
Identify and manage specific gastrointestinal illness
Treat Genitourinary Symptoms\u2026\u2026\u2026\u2026 \u2026\u2026... \u2026\u2026\u2026\u2026 \u2026\u2026\u2026 \u2026\u2026\u2026\u2026 \u2026\u2026\u2026....44-59
\ue000
Recognize specific illnesses
\ue000
Recognize Sexually Transmitted Diseases
\ue000
Review Male and Female Catheterization
Treat Skin Disorders\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..\u2026\u2026\u2026\u2026\u2026\u2026\u202660-73
\ue000
Assess for Skin Disorders
\ue000
Identify and Manage Viral Disorders of the Skin
\ue000
Identify and Manage Bacterial Disorders
\ue000
Identify and Manage Inflammatory Disorders
\ue000
Identify and Manage Fungal Infections of the Skin
\ue000
Identify and Manage Other Skin Disorders
Treat infectious Disease & Immunologic Symptoms\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026..74-92
\ue000
Review Concepts Associated with Infectious Diseases
\ue000
General Assessment of Suspected Infectious or Communicable Disease
\ue000
Assess and Treat Eye, Ear, Nose, Throat, and Respiratory Complaints
\ue000
Assess and Treat Gastrointestinal (GI) Complaints
\ue000
Assess and Treat a Fever, Headache, and Sinus Symptoms
\ue000
Assess and Treat Hepatitis
\ue000
Assess for Human Immunodeficiency Virus (HIV)
\ue000
Assess and Treat for Lyme Disease
\ue000
Identify Viral Diseases of Childhood
\ue000
Reporting an Exposure to an Infectious/ Communicable Disease
Appendix A \u2013 Insert and Remove NG Tube Catheter, Competency Skill Sheets
Appendix B - Insert and Remove Foley Catheter, Competency Skill Sheets

Academy of Health Sciences
91W10
Treat Metabolic Endocrine Symptoms

1
TERMINAL LEARNING OBJECTIVE

Given a standard fully stocked M5 Bag or Combat Medic Vest System, IV administration
equipment and fluids, oxygen, suction and ventilation equipment (if available) and
glucometer. You encounter a casualty who has a metabolic and endocrine systems
problem.

Principles of glucose metabolism

All body cells use glucose as an energy source
The brain requires a constant supply of glucose
The blood stream delivers glucose to the cells for use as energy
Insulin must be present for glucose to enter the cells
Glucose and insulin balance are necessary for effective metabolism and use of
glucose as an energy source

Without insulin
(1)
Glucose cannot enter the cell from the bloodstream
(2)
Acids are formed when fat is used for energy needs and can lead to
diabetic ketoacidosis
The three Ps of weight loss occur when glucose is not adequately
metabolized. Frequently seen in undiagnosed diabetics.
(1)
Polyuria \u2013 The excess amount of glucose in the blood forces water
into the bloodstream. The extra water is secreted as excess urine.
(2)
Polydipsia \u2013 increased thirst that results in increased water drinking.
Secondary to increased volume of urine.
(3)

Polyphagia \u2013 The cells and tissues cannot utilize the sugar in the blood; therefore, the cells begin to starve. This starvation causes hunger and excessive eating.

(4)
Weight loss \u2013 The cells cannot use the sugar, so they break down fat
and protein for energy causing weight loss
Assess the casualty for hypoglycemia and hyperglycemia
Hypoglycemia is a true medical emergency!
Hypoglycemia
(1)
Generally defined as a serum glucose level of less than 50 mg/dl
(2)
Signs and symptoms (tachycardia, cool, moist or clammy skin,
dizziness, complaints of hunger) are consistent with the diagnosis
(3)
Signs and symptoms are resolved following glucose administration.
Causes of hypoglycemia
(1)
In an insulin-dependent diabetic is often the result of too much
insulin, too little food, or both
(2)
A diabetic who has not eaten does not have enough dietary intake of
glucose to use for a circulating level of insulin
(3)
Excessive exercise or exertion uses up the glucose energy stores
(4)
Vomiting or diarrhea depletes the body of fluids, electrolytes, and
potential sources of glucose
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