Page 123 - 2022 Ranger Medic Handbook

Deep Venous Thrombosis (DVT)
DEFINITION: Potentially life-threatening condition in which a clot is present in the large veins of a leg and may dislodge
and localize in the pulmonary system, a pulmonary embolism.
S/Sx: History of recent trauma, air travel, altitude exposure, birth control pills, or family history of DVT; asymmetric pain
and swelling in a lower extremity (often the calf muscles); warmth over affected area; increased pain in the affected calf
muscles with dorsiflexion of the foot; palpable venous “cord.”
MANAGEMENT:
1. Monitor patient with pulse oximetry (sudden decrease in oxygen saturation or new chest pain/shortness of breath
suggests a pulmonary embolism).
2. Acetylsalicylic acid (aspirin) 325mg PO q4–6hr.
3. Immobilize the affected extremity and do not allow to walk.
4. For associated respiratory distress (tachypnea, tachycardia, dyspnea, chest pain) consider pulmonary embolus and
treat per Chest Pain Protocol. SECTION 3
DISPOSITION: Priority evacuation if no respiratory distress or chest pain. Urgent evacuation If respiratory distress or
chest pain are present
SPECIAL CONSIDERATIONS: May be confused with a ruptured Baker’s cyst in a tactical setting.

Dehydration
DEFINITION: Inadequate fluid intake exacerbated by physical exertion or illness.
S/Sx: Lightheadedness (worse with sudden standing); mild headache (especially in the morning); dry mucosa; de-
creased urinary frequency and volume; dark urine (tea colored); degradation in performance
MANAGEMENT:
1. Assess for underlying condition and treat as per appropriate protocol in conjunction with this protocol.
2. Increase oral fluids if tolerated.
3. If available, use carbohydrate/electrolyte drink mixes for fluid replacement diluted to a 1:4 solution.
4. Avoid fluids containing caffeine.
5. If unable to tolerate PO fluids, use an initial bolus of 1L crystalloid IV, followed by repeat attempt at PO hydration. If
still unable to tolerate PO hydration, repeat 1L bolus of crystalloid IV.
6. Treat per Nausea/Vomiting Protocol as needed.
DISPOSITION: Monitor closely for recurrence of dehydration. Priority evacuation if dehydration persists after treatment.
SPECIAL CONSIDERATIONS:
1. Troops in the field are often chronically dehydrated.
2. Prolonged missions, acute diarrhea (gastroenteritis), viral/bacterial infections, and environmental factors (heat stress
or strenuous activity) all may exacerbate dehydration.
3. May also occur in cold or high altitude environments.
Dengue Fever
DEFINITION: A flaviviral disease transmitted by the Aedes aegypti and albopictus mosquitoes.

S/Sx: Can be dormant for 1–7 days. Patients will have high fever with at least two of the following: severe HA, severe
retro-orbital PN, arthralgias, myalgias, rash, or petechiae. Hemorrhagic manifestations may include purpura/ecchy-
mosis, epistaxis, gum bleeding, blood in emesis, urine, or stool, or vaginal bleeding.
MANAGEMENT: Refer to higher medical care if suspected DF. Management is mostly supportive focusing mostly on
maintaining blood pressure and perfusion. Initiate Tylenol 1,000mg q6hr.
DISPOSITION: Urgent evacuation for suspected DF, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS).
SPECIAL CONSIDERATIONS: Most commonly found in tropical Asia, Central and South America, and the Ca-
ribbean Dengue is the leading mosquito-borne infection. The Aedes prefers to feed in the daytime. Their bites can
go unnoticed. One mosquito can infect multiple people. Dengue can be transmitted by blood transfusions and organ
transplants but no recorded person-to-person transmission. Someone can be infected with any of the dengue viruses
and never develop DF. There is no vaccine or chemoprophylaxis for any of the dengue viruses. The primary means of
prevention is eliminating the mosquito breeding habits, wearing clothing properly, using insect repellent, and mosquito
nets. If a person has been infected with the dengue virus previously and is exposed again, they are at risk for either DHF
or DSS, which could be fatal.

2022 RANGER MEDIC HANDBOOK 109