Page 142 - 2022 Ranger Medic Handbook

Nausea & Vomiting
DEFINITION: Nausea and vomiting usually as a result of underlying medical condition and managed in conjunction with
other protocols.
S/Sx: Nausea and vomiting
MANAGEMENT:
1. Ondansetron 4–8mg IV/IM/SL or 8mg PO q4hr prn OR promethazine 25mg IV/IM/PO q6hr prn OR diphenhydramine
25–50mg IV/IM/PO q6hr prn.
2. Treat per Dehydration Protocol.
3. Use in conjunction with appropriate protocols.
DISPOSITION: Evacuate per protocol for underlying condition.
SECTION 3 SPECIAL CONSIDERATIONS:
1. Avoid rapid IV administration of promethazine.
2. DO NOT give subcutaneous promethazine.
3. Diphenhydramine and promethazine may cause drowsiness and therefore not recommended during combat opera-
tions or training.

Otitis Externa
(Outer Ear Infection or Swimmer’s Ear)
DEFINITION: Bacterial or fungal infection of external ear canal, “swimmer’s ear.”
S/Sx: Ear pain and pain with passive ear movement, tragus swelling, erythema, pruritis in area; possible exudate and
erythema in ear canal, decreased auditory acuity, sensation of fullness, and moisture in ear.
MANAGEMENT:
1. If external canal exudate is present, Ofloxacin Otic 0.3% 10 drops in affected ear daily × 7–10 days OR gatifloxacin
ophthalmic 0.3% 5 drops tid–qid × 7–10 days (for both – administer while awake and laying on unaffected side for at
least 5 minutes); ophthalmic used to minimize meds carried.
2. Place sterile dry dressing wick into ear canal to keep canal open and allows meds to reach inner canal with canal
edema.
3. Acetaminophen 1,000mg PO q6hr prn pain.
4. No internal hearing protection until resolution.
5. If no response or worsens, treat with ciprofloxacin 750mg PO bid and urgent evacuation (concern for malignant otitis
externa).
DISPOSITION: For uncomplicated cases, no evacuation is necessary. Urgent evacuation for complicated cases not
responding to therapy or if condition worsens despite 12–24 hours of treatment with ciprofloxacin.

128 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL