How to avoid trouble on the high seas. Kelly R. Klein Fmr 100 ton aux sail license holder ER doc Maimonides Medical Center Brooklyn, NY

Transcription

1 How to avoid trouble on the high seas Kelly R. Klein Fmr 100 ton aux sail license holder ER doc Maimonides Medical Center Brooklyn, NY

2 Overview How to spot a bad apple Crew issues Passenger issues Quick fixes Answer questions when and if you have any

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4 What you need to survive Oxygen Physiological core temperature Water Food The Will to survive

5 What are you preparing for? Day Sail: within 12 hours Coastal Cruising: approx. 24 hours Blue Water Sailing: approx. 3 days Ocean Sailing: a week or greater

6 Taking a history and red flags Past medical history Past surgical history Allergies Medications prescription homeopathic Vaccinations

7 Medicines Benadryl (pills and injectable) Tylenol Motrin Pepto bismol Ducolax Bacitracin Viscous lidocaine Oral glucose Epi pen Inhaler with spacer Lidocaine (injectable) Antibiotics Doxycycline Ciprofloxacin Keflex

8 Colors Blue cyanosis medications Red infection burn Grey sea sickness badness Yellow liver problems

9 Environmental Issues Hypothermia Dry clothes Food Liquids Add heat

10 Rashes Location What does it look like?

11 Red eye Use a nasal cannula and normal saline if available. If not you can just gently pour water gently over the bridge of the person s nose, it will flush out the eye Conjunctivitis (pink eye) very contagious.

12 If angulated, check for pulse Splint with padding If open cover with moist sterile dressing, give antibiotics if available. Fractures

13 Dislocations

14 Dislocation Reduction Traction in line When in place, immobilize Ibuprofen/Tylenol for pain

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16 Ow!!!! Sh*t, Mother... Subungual Hematoma Spin 18 gauge needle btw fingers Heated paper clip Cautery tool

17 Superficial Partial thickness Full thickness Burns

18 Burns hospital >10 TBSA Full thickness >5% Inhalation injury Circumferential Diabetes Face/eyes Genitalia Joints

19 Burn treatment Stop the burning Bacitracin Encourage drinking of fluids for good hydration Pain control (motrin) Keep clean Maintain body heat

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21 Laceration Make sure it is clean Irrigate Bleeding controlled After approx. edges, might have to splint for a few days so it will not dehisce Anesthesia as necessary

22 Lacerations Steri strips Tincture of benzoin Dermabond (super-glue) Staples/sutures Bacitracin Glue caveats Do not get into the wound Do not get into the eyes

23 Hair tie Text Crazy Glue

24 Anaphylaxis/Allergic Reaction

25 Anaphylaxis/Allergic Reaction Epi pen Benadryl Steroids H2 blocker (pepcid, tagament)

26 Odd ball things Asthma inhaler steroids Dental Oil of clove Viscous lidocaine Motrin

27 Can t catch breath

28 water, water everywhere... pee: 1200 cc insensible: 1000 cc poo: 300 cc Minimum intake: 1800 cc

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30 QuickTime and a a TIFF (Uncompressed) decompressor are needed to see this picture. TIFF (Uncompressed) decompressor are needed to see this picture.

31 Bloody Urine Renal Stone Hemorrhagic Cystitis

32 Epilepsy Drugs Trauma Seizures

33 Seizures Let the person seize Keep them away from edges and high places Think about the most likely causes with-drawls hypoglycemia head injury temperature extremes cardiac

34 Dehydration Sun Vomiting Diarrhea Medications Headache

35 Dehydration Do not let it happen Rehydration salts diaoralyte 1/3 strength gatorade

36 Environmental Issues Hyperthermia Sun stroke Heat stroke Muscle cramps

37 Acting Funny Drugs/alcohol Hypoglycemia Head bleed Seizure Stroke

38 Depression Most know the classic signs and symptoms Antidepressant medications may lend themselves to either sun sensitivity or dehydration (nausea and diarrhea) Be wary of the person who all of a sudden has a change of attitude

39 Bites All bites deserve antibiotics, they all get infected.

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41 Diabetes Altered mental status Seizures Unresponsive Coma/Death When they arouse then feed with carbohydrates Glucagon pen Oral glucose

42 Facial Droop Stroke Botox gone bad Bell s Palsy

43 Bleeding Tourniquet Bleeding eventually stops ASA Plavix Hemophilia

44 Cardiac Arrest AED In the adult, dysrhythmia is the culprit.

45 Cardiac Arrest No need to breath often for the victim Fast and effective compressions

46 Child Birth Very easy and natural

47 Heroics burr holes in the skull to drain a blood clot appendectomy pen for an airway re inflate a lung

48 Questions? Kelly Klein