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MEDICAL ISSUES
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Medical Readiness
• Your Crew
– Mids and Civilians
• Your Vessel
– Navy 44
• Your Destination
– Newport
– ?
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Medical Readiness for The Crew
• Pre-existing medical problems:
– Some common are hypertension, chronic back pain, and heart disease.
• Individual Medications:
– Who takes what? Do they have a supply for the duration?
• Serious Allergies
• Smokers and Drinkers (At sea is not the time to quit)
• Seasickness
• A Summary Medical Record for Each Member
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1. Your medical conditions requiring regular attention
2. Past surgeries and inactive medical problems
3. Medications and allergies
4. Who to call in an emergency
Medical Questionnaire
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Medical Readiness for Your Vessel
• Secure Storage: Will anything fly if you suffer a knockdown?
• Do you have a preventer? If not, can you perform neurosurgery underway?
• Secure harnesses and jacklines
• A comprehensive medical locker
• Communication Link: Primary and Secondary
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
c. Ensures personal, food handling, head and boat hygiene standards are maintained.
d. Supervises or provides application of first aid and CPR afloat.
e. Supervises and records use of medicines.
f. Seeks external advice for and recommends disposition of ailing crew.
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
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Seasickness Food and Drink
• Foods– Ginger Snaps– Saltine crackers– Less acidic fruits (apples, bananas, pears, grapes,
melons, etc.), – Breads (muffins, croissants, rolls), cereals and grains as
alternatives.
• Drinks– Ginger Ale– Coke, Pepsi– Milk, water, apple juice, cranberry juice
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• Do not eat/drink….
– Greasy or acidic foods for several hours before sailing.
– Coffee, bacon and eggs, sausage, waffles or pancakes with syrup,
– Acidic juices, orange juice, grapefruit
• Caffeinated beverages should be avoided, as they are diuretics which accelerates dehydration.
• Be sure to test medications or remedies on land before your trip, to make sure any side effects are not severe.
Seasickness Food and Drink
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Medical Response: Seasickness
• Mismatch between what your middle ear feels and what your eyes see.
• Steer the boat for awhile. Do something on deck.
• Stabilize your neck with a c-collar or towel wrap.
• Lie down, neck stabilized, head slightly elevated, in the lowest center point.
• Meclizine (Bonine) is good before you go.
• Compro - Prochlorperazine Suppository
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
c. Ensures personal, food handling, head and boat hygiene standards are maintained.
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Hygiene Standards
• Wash your hands
• Wash your dishes and utensils
• What do we have to clean with?
– Alcohol
– Waterless hand sanitizer
– Regular soaps
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
c. Ensures personal, food handling, head and boat hygiene standards are maintained.
d. Supervises or provides application of first aid and CPR afloat.
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Trunk Monkey
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Common Illnesses and Injuries
• Seasickness / Dehydration
• Hyperthermia / Heat Exhaustion / Sun Sickness
• Hypothermia
• Lacerations and Contaminated Wounds
• Broken bones, injured backs, pulled muscles, wrist tendonitis
• Devastating Injuries: Head Trauma, Heart Attack, Major Burns
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Hypothermia
• Can be subtle, like dehydration, can impair judgement and performance
• Wind and being wet lead to rapid heat loss
• Obey the Ocean Dress Code: Layer upon Layer!
• Treat it by: Strip him, Dry him, Rack and Sack him, Hot Liquids
• WARM THE CORE FIRST: THE LIMBS WILL WAIT
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Hyperthermia
• Heat exhaustion is just that, too tired, too hot. Left unchecked, it becomes...
• Heat Stroke, a slowly frying brain
• Cool the core with cold fluids, cool the limbs with cold liquids and a fan
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Sun Sickness
• Sunblock: 30 grade, waterproof, twice a day. Apply esp.. to the ears and tip of your nose.
• Late stage Melanoma is lethal, so look for it first:
-irregular speckled border
-bizarre and inconsistent coloration
-history of rapid growth
• Fair skinned folks should perform a mole check once a month.
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Lacerations and Wounds
• Obey the 3 Rules of Managing Wounds: 1. Open it till you see or feel the bottom. 2. Clean it.3. Make sure the rest of the limb still works.
• NEVER, EVER, CLOSE A DIRTY WOUND. Infection and death may ensue.
• If in doubt, clean it, pack it with clean gauze, and leave it open
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Boom to the back of the head.
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You must see the bottom of the wound
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Rinse, Rinse, Rinse.
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Staple/tape it together. Keep the edges up
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3 Types of
External
Bleeding
Arterial
Capillary
Venous
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Direct Pressure
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Elevation
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Pressure
Bandage
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Pressure Point – Brachial
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Pressure Point – Femoral
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A tourniquet is a last resort.
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Managing a
Simple
Nosebleed
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Skull Fracture
May cause loss of blood or clear fluid
(cerebrospinal fluid) from the nose and
ears.
HALO test
Do not stop the flow of fluid.
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Signs & Symptoms
of Internal Bleeding
Significant MOI
Pain, tenderness, deformity, swelling,
discoloration
Tender, rigid, or distended abdomen
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Signs & Symptoms of Shock
Restlessness, changes in mental status
Pale, cool, and clammy skin
Increased pulse rate
Increased respiratory rate
Nausea and vomiting
Dilated pupils
Thirst
Cyanosis
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Elevate lower extremities 8-12 inches.
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Prevent loss of body heat.
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Allergic Reaction
An exaggerated reaction by the body’s
immune system to any substance
Anaphylaxis
A life-threatening allergic reaction which
causes shock (hypoperfusion) and airway
swelling
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Common Allergens (Causes) of Allergic
Reactions
Insect stings
Foods
Medications
Plants
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Signs and Symptoms
Itchy, watery eyes and
runny nose
Headache
Sense of impending
doom
Generalized
Findings
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Signs and Symptoms
SkinItching
Hives
Flushing
Warm, tingling feeling
Swelling (especially
face, neck, hands,
feet, tongue)
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Signs and Symptoms
Tightness in throat/chest
Cough
Rapid, labored, noisy
breathing
Hoarseness
Stridor and wheezing
Respiratory
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Emergency Care of
Allergic Reactions
Reassess in 2 minutes.
Record reassessment findings.
If patient does not have epinephrine auto-
injector, consult medical direction.
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Sources of Burns
Thermal
Chemical
Electrical
Light
Radiation
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Classifying
Burns
by Depth
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Body Surface Area
A burn equivalent to the size of the
patient’s hand is equal to 1% body
surface area (BSA).
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Rule of Nines
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Emergency Care of Burns
Monitor the airway for closure.
Cover burn area with dry, sterile
dressing.
Do not use ointments/lotions.
Do not break blisters.
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Types of
Musculoskeletal Injuries
Fracture
Bones break
Dislocation
Joints “come apart”
Sprain
Stretching & tearing of ligaments
Strain
Overexertion of muscle
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Signs & Symptoms of
Musculoskeletal Injuries
Pain and tenderness
Deformity or angulation
Grating (crepitus)
Swelling
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Muscles, Bones, and Backs
• RICE it:
1. Rest it
2. Immobilize it with a splint.
3. Cold and Compress it.
4. Elevate it.
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Splinting – General Rules
Assess distal pulse, motor function,
and sensation (PMS) before & after
application.
Immobilize joints above & below injury.
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Splinting – General Rules
Remove or cut away clothing.
Cover open wounds with sterile
dressings.
Do not replace protruding bone ends.
Pad splint and void areas.
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Long-Bone SplintingStabilize extremity manually.
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Assess distal PMS
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Make sure splint extends several inches
beyond joints above/below injury.
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Apply splint. Immobilize joints
above/below injury.
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Secure extremity to splint.
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Secure foot or hand in the
Position of function.
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Reassess distal PMS.
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Joint Immobilization:Stabilize injured area manually.
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Assess distal PMS.
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Immobilize injury site and bones
above and below.
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Reassess distal PMS.
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Assess PMS; position sling.
Tie swathe around sling.
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Splint for Injured Forearm
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Spine Immobilization
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Splint for Injured Finger
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Fractured toes. Buddy tape it.
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Chest Pain
•Cardiac Chest Pain•Dull ache, pressure sensation•Substernal, radiates to arms, neck•Not worsened by movement or respiration•Not affected by pressing on it•Not relieved by antacids•Lasts more than 3 minutes
•Non-Cardiac Chest Pain•Sharp, stabbing•Localized, non-radiating•Provoked with movement or respiration•Worsens when pressing on it•Relieved by antacids•Short-lived, less than 30 seconds
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Basic Life SupportCPR Review
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Mr Bean does CPR
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How CPR Works
•Effective CPR provides 1/4 to 1/3 normal blood flow
•Rescue breaths contain 16% oxygen (21%)
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Start CPR Immediately
•Better chance of survival
•Brain damage starts in 4-6 minutes
•Brain damage is certain after 10 minutes without CPR
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Even With Successful CPR, Most Won’t Survive Without ACLS
• ACLS (Advanced Cardiac Life Support)
• ACLS includes defibrillation, oxygen, drug therapy
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ABC’s
• Airway
• Breathing
• Circulation - Bleeding
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Checking Vital Signs
•A – Airway
–Open the airway
–Head tilt chin lift
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B – Check For Breathing
•Look, listen and feel for breathing
– No longer than 10 seconds
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Breathing
• If the victim is not breathing, give two breaths (1 1/2 seconds or longer)
– Pinch the nose
– Seal the mouth with yours
• If the first breath doesn’t go in,
re-position and give a second breath
(if breaths still does not go in, begin CPR)
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Compressions
• After giving breaths…
• Locate proper hand position for chest compressions
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Compressions
– Using both hands, give 30 chest compressions
– Depth of compressions:
1.5 to 2 inches
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CPR
•After 30 chest compressions give:
•2 breaths
•Continue until help arrives or victim recovers
• If the victim starts moving: check breathing
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Choking
• The tongue is the most common obstruction in the unconscious victim (head tilt- chin lift)
• Vomit
• Foreign body
– Foods
• Swelling (allergic reactions/ irritants)
• Spasm (water is inhaled suddenly)
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How To Recognize Choking
• Can you hear breathing or coughing sounds?– High pitched breathing sounds?
• Is the cough strong or weak?
• Can’t speak, breathe or cough
• Universal distress signal (clutches neck)
• Turning blue
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Recognizing Choking
•A partial airway obstruction with poor air exchange should be treated as if it were a complete airway blockage.
•If victim is coughing strongly, do not intervene
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Conscious Choking(Adult Foreign Body Airway Obstruction)
• Give abdominal thrusts (Heimlich maneuver)
–Place fist just above the umbilicus (normal size)
– Give upward and inward thrusts
• Continue until successful or victim becomes unconscious
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If Victim Becomes
Unconscious After Giving Thrusts
• Try to support victim with your knees while lowering victim to the floor
• Assess
• Begin CPR
• After chest compressions, check for object before giving breaths breaths
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
c. Ensures personal, food handling, head and boat hygiene standards are maintained.
d. Supervises or provides application of first aid and CPR afloat.
e. Supervises and records use of medicines.
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Pharmacology
• Ibuprofen 200 mg – anti-inflammatory– 400mg every 4-6 hrs use lowest effective dose give with food
• Tylenol Regular strength – acetaminophen– Pain, fever – 325-1000mg by mouth
• Peptic Relief -- Bismuth Subsalicylate (Kaopectate, Pepto-Bismol) – Diarrhea (acute)– 2 tablets by mouth every 1hr as needed; Max 4200 mg/24 hrs
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Pharmacology
• Hydrogen Peroxide 3% topical solution
– First Aid antiseptic (wound cleansing)
• 1-3x day, let dry before bandaging
– Oral debriding agent (can use as gargle or rinse)
• Mix 50/50 with water, swish for 1 minute
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Pharmacology
• Clotrimazole Cream – Antifungal
• Hydrocortisone Cream 1%– Anti-itch, dermatoses
• Antibiotic ointment – Bacitracin– superficial infections
– max 5x day – 7 days
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Pharmacology
• Cepacol – sore throat
• Aprodine tablets – triprolidine and pseudoephedrine hydrochloride– Colds
• Pseudoephedreine 30 mg – nasal congestion
– 60 mg every 4-6 hrs; max 240 mg in 24 hrs
– caution with beta blockers, monitor blood pressure
– common reactions include; insomnia, nausea, headache, dizziness
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Pharmacology
• Meclizine Hydrochloride - Antivert
– motion sickness
– 25-50 mg by mouth (chewable) every 24 hrs
– caution with aspirin and muscle relaxant combo –psychomotor impairment
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Pharmacology
• Banophen – Diphenhydramine HCl 25mg (Benadryl)
– Allergic reaction
– 25-50 mg by mouth every 4-6 hrs as needed; max 100 mg/dose or 400 mg/day
– also for insomnia and sedation,
– plus motion sickness start 30 before exposure
– common reactions; sedation, dizziness, incoordination
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Pharmacology
• Compro - Prochlorperazine Suppository
– Nausea/vomiting, severe
– 25mg every 12 hrs
– Reactions include: drowsiness, dizziness, blurred vision
– subclass of n/v and anti-psychotics
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CRUISING SKIPPER (D-CS) PQS
• Medical
a. Maintains and inventories medical kit.
b. Ensures supply of seasick-friendly foods and drinks available.
c. Ensures personal, food handling, head and boat hygiene standards are maintained.
d. Supervises or provides application of first aid and CPR afloat.
e. Supervises and records use of medicines.
f. Seeks external advice for and recommendsdisposition of ailing crew.
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Communications
• Marine VHF
• Single Side Band
• SATPHONE
• Cellular Phone: effective to 20 miles offshore
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Medical Resources Available
Emergency Medical Problems call for Coast
Guard MedEvac
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Medical Resources Available
• Each OTC STC and MIDN STC is equipped with a Satellite Phone (SATPHONE).
• Other STC contact the OTC
• If unable to establish comms with the OTC,
– HF comms with the Operator. Have the Operator call the number of the nearest naval medical facility.
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What do you have?
• Patient’s Name
• Age/Sex
• Accident/Injury/Illness
• Mechanics of injury or history of present illness
• Vital signs (temperature and pulse)
• Pertinent physical exam findings
• Treatment already rendered
• Allergies
• Pertinent medical history
• Current medications, if any
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Who to call
• Annapolis, MD:Clinic (410) 293-1758/59
(During working hours)
Emergency (410) 293-3333
(24 hours a day)
• Newport, RI:Medical Clinic (401) 841-3771
(24 hours a day)
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What to do in an Emergency
• Stay calm. People rarely die suddenly.
• Move the patient to a secure bunk.
• Splint and immobilize the neck of anyone complaining of neck pain before you move.
• Find out exactly what happened.
• Call your medical resource: Report the situation clearly and calmly.
• Clarify all advice you receive.
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Boat Fire