Presentation on theme: "Medicine For Mariners “101”"— Presentation transcript:
1Medicine For Mariners “101” Robin B. Garelick, MD, FACEPSV Quantum Leap
2Objectives Learn and Have Fun Common Medical Conditions SeasicknessHypothermiaHyperthermiaSunburnTraumaMarine EvenomationWound CareCustomizing a Medical KitBasic First Aid TipsFuture Topics and Workshops ?
5SeasicknessThroughout the world, it is the most frequent medical problem responsible for maritime search and rescue.Primarily during stormy weather.Can cause a lack of will to persevere in stormy weather and rough seas.“Wet, seasick and scared - they want to go home”.
6Seasickness can cause… Mental DeteriorationPhysical DeteriorationProgressive DehydrationLoss of Manual DexterityAtaxia (walk like you’re drunk!)Impaired JudgmentAfter several hours of illness - loss of will to surviveFatalities due to poor seamanship & complications during emergency evacuation
11Basic Underlying Mechanism of Seasickness Your body, inner ear and eyes all send different signals to the brain.A disturbance occurs in the inner ear.Fluid within the vestibular system shifts in relationship to position.Position sensors in our muscles and joints send signals to the brain based upon our movements.Our eyes may have a fixed position when below deck or trying to read.Neural mismatch occurs while we are in motion.
13The inner ear & it’s 3 canals Semicircular CanalsPurpose of canals is so we stay balanced and live in 3D world3 Planes of SpaceUp-DownLeft-RightFront-Back
14The anatomy of motion sensors… Canals are lined with haircells.The fluid in the canals is called endolymph.The haircells are our motion sensors and when the endolymph moves - a message is sent to our brain.
15The neural mismatchDopamine (neurotransmitter) is released and triggers a chemoreceptor zone in the brain which activates our “vomit” center.Initial response to the neural mismatch occurs at the brainstem level.So how do we prevent this or blunt the response????AKA: How to get your sea legs.
16Getting your sea legs… Occurs over 24 to 72 hours. For many - the brain learns to compensate over time and you accommodate.Medication prevents symptoms but may not completely reverse once they occur.After a prolonged period of time at sea the reverse occurs as you get used to being on land.
17Signs and Symptoms Sleepiness and excess yawning Nausea (stay positive and tell yourself you won’t vomit)Extreme Nausea and VomitingDizzinessHeadachePallorCold SweatsDepressionLack of interest
18Seasickness TriggersGoing below deck for extended periods of time while underway.Looking through binoculars for extended periods of time (stabilizing binoculars).Reading a book, focusing on compass, detailed work or staring at one point.Keep peripheral vision on the horizon and not staring at an object your brain will interpret as stable because your semicircular canals are screaming motion.
20Preventative Measures Avoid alcohol.Get plenty of rest before departing.Drink plenty of water and stay hydrated.Avoid heavy foods and fatty meals while underway.Consider seasickness aids.GingerHomeopathicsAccupressure/Seasickness Bands
21Medications for Seasickness Antihistamines:Meclizine (Bonine, Non -drowsy Dramamine)Cyclizine (Marazine)Diphenhydramine (Benedryl)Cinnarizine (Stugeron)Anticholinergics:Scopolamine (Transderm-Scop)AntiemeticsPromethazine (Phenergan tablet or suppository)Prochlorperazine (Compazine)Metoclopramide (Reglan)Odansetron (Zofran)
23Hypothermia AKA: I’m Cold Primary & Secondary HypothermiaPrimary: Cold ExposureSecondary: Medical Conditions or Medications that prevent response to cold or predispose to heat loss.Immersion (Man overboard!!!!)Acute versus Chronic
24Hypothermia DefinedMild Hypothermia: core temperature below 95o to 89.6o.Moderate Hypothermia: core temperature below 89.6o to 82.4o.Severe Hypothermia: core temperature less than 82.4o.We set 86o as the CRITICAL Temperature.Mild and early moderate hypothermia are treatable without emergency medical intervention & rescue.
25Acute vs.Chronic Hypothermia Thermal Conductivity of water: 25 times greater than air.Acute Hypothermia develops in minutes to hours after sudden immersion in cold water.Chronic Hypothermia develops over hours to days when inadequate protection from cold wind and wet spray.
26Predictable Rate of Cooling Based on water temperatureBody shape (short round bodies cool slower than tall thin bodies).Insulating fat layers (finally an advantage to having more sub-q fat).If immersed - activity during immersion (less is better).Amount of body immersed.Protective clothing being worn.
27How do we preserve heat ?Divert warm blood from the surface to our core.skin and muscles to the brain, heart, lungs, kidney and liver.The decrease in surface blood flow improves insulationShivering occurs to produce heat by increasing metabolic activity. Max shivering at 89.6o to 91.6o.Hypothermia develops when heat loss exceeds heat conservation.Muscle rigidity occurs at 86o.Voluntary shivering stops with we are unable to rewarm ourself.
28Signs and Symptoms Clumsiness in activity. Difficulty walking (especially with heavy gear or clothing).Subtle changes in mental status which impair judgment (confusion and disorientation).Decreased responsiveness to verbal and painful stimuli.Coma and unconscious state in severe hypothermia.
30Treatment of Hypothermia Initial treatment in mild hypothermia:Take shelter from wind and water.Replace wet clothing with multiple layers of dry insulated garments that make the skin feel dry.If no dry clothing then add an extra layer of foul weather gear.Wrap in blankets, sleeping bag, sail or sailbags.Feed simple carbs and light sweet beverages (warm preferred)Allow shivering to continue for self rewarming.In moderate to severe hypothermia - evacuation is required for emergency medical intervention.
31Treatment of Hypothermia In moderate to severe hypothermia:Heart can be stunned into ventricular fibrillation - therefore handle the victim gently.Lay victim flat.External hot packs to the armpits, groin, chest wall and neck to stabilize body temperature.Cuddle to help stabilize their body temperature.Cough and gag reflexes are diminished - do not try to give hot liquids or food.
32Remember to keep them bundled and protected from cold. Helicopter rescue may incur winds of 100 mph from prop downwash and increase wind-chill for the hypothermic victim.
36Hyperthermia AKA: I’m hot Definition:A medical condition arising when the body’s capacity to lose heat does not match the total body heat load.Occurs when a normal physiologic response becomes pathophysiologic (body temperature > than the brain set point).
37Types of Heat IllnessHeat Rash: rash caused by plugged sweat glands and we get a secondary inflammatory reaction.Heat Edema: self limited swelling of the hands and feet seen early in heat exposure.Heat Cramps: muscle cramps associated with exercise and secondary to loss of sodium.Heat Syncope: fainting from dilatation of the surface blood vessels from high temperature.Heat Exhaustion: Loss of circulating volume in the face of heat stress.
39Types of Heat IllnessHeat Stroke: complex clinical condition characterized by:Core temperature of 104o to 106o.Neurologic Changes (aka: change in mental status)Multiorgan dysfunction can occur - breakdown in ability of kidneys and heart to function within normal limits.
40How do we lose heat ? Radiation: 65% of heat loss Conduction: < 2% of heat loss (increases when immersed in water)Convection: 10% of heat lossRespiration/Breathing: 5% of heat lossEvaporation: 35% at rest and up to 75% of heat loss with activity.Most effective means of heat loss BUT at 95% humidity, evaporation no longer occurs.
41Factors that Predispose us to Hyperthermia Prolonged exertionPoor muscle conditioningInability to acclimate to the temperatureSleep deprivationDisease statesCardiac, dehydration, endocrine disorders, skin disorders, infections, seizures, etc.
42Factors that Predispose to Hyperthermia Rapid change in humidity or temperatureHeavy and/or constrictive clothingExtremes of age - the very young and the very old…Medications & DrugsAnticholinergics: TCA’s and PhenothiazinesAmphetamines & CocaineDiuretics (water pills)AlcoholBeta Blockers (drugs that end in -ol)Alpha agonists
43Signs and Symptoms of Heat Exhaustion MalaiseWeakness (low blood pressure)HeadacheDecreased AppetiteNausea/VomitingIncreased heart rateProfuse sweating
44Heat StrokeTrue Medical Emergency that requires rapid cooling measures:While awaiting assistance - remove excess clothing.Try cooling methods such as body misting, fan, cool wet sheets r ice packs to the groin, axilla, neck and chest area.Rapid cooling improves survival.
46Treatment of Hyperthermia Hydration, hydration, hydration!!!“If you can read the newspaper through your urine - you’re well hydrated.”Electrolyte drinks like Gatorade or Powerade (avoid salt tablets).Avoiding excess heat with medication/medical conditions that predispose to heat illness.Decrease alcohol consumption.Minimize sun exposure.Avoid sleep deprivation.Decrease outdoor activity/exercise routines and shift to an indoor environment.
47Treatment of Hyperthermia Avoid sleep deprivation.Decrease outdoor activity/exercise routine and shift to indoor environment.Cold showers/transom shower/anchor washdown.If going to a hot climate - acclimate slowly over a period of 1 to 2 weeks.
48Sunburn and Solar Injury Sunburn is classified as a thermal injury.Red, hot painful 1st degree burns show up 2 to 6 hours after exposure.2nd degree burns occur when there is swelling, blisters and subsequent peeling.
51Sunburn PreventionSchedule water activities (when possible) in early morning or late afternoon hours.Chemical sunscreens (PABA) absorb UV rays and require application at least 30 to 60 minutes prior to sun exposure so they can penetrate the deep layers of the skin.Physical sunscreen (zinc oxide) act as physical shields and reflect or scatter light. They are effective immediately.Use on high exposure areas: lips. ears, facial areas.
52Sunburn PreventionReapply liberally every 2 to 3 hours and more frequently if in and out of the water or excess perspiration.Waterproof formulations last 2X longer than water resistant formulations.Consider UV block clothing and hats that cover sensitive areas (face/ears/neck/scalp)
53Sun Related Eye Injuries Excess UV Radiation can lead to cataracts and damage to the retina.Photokeratitis is a “sunburn” type injury to the cornea:Intense eye painIncreased tearing & rednessSpasm of the eye itself as well as the lid
54Sun Related Eye Injuries Pain & temporary loss of vision starts in 4 to 12 hours.Treatment is with antibiotic ointment or solution.Bacitracin Ophthalmic OintmentPolytrim Eye DropsCipro Eye Drops (Contact lens wearer)Avoid bright light after a photosensitivity injury (24 hours).Pain medicationSunglasses that block UVA & UVB with a wide brimmed hat.
55Photosensitivity Reactions Exagerrated sunburn or rashes triggered by sun exposure after taking a particular medication or applying a chemicla or plant extract to the skin.Burn appears immediately and lasts up to 2 to 4 days.May get hives or poison ivy type rash.
56Treatment of Photosensitivity Reactions Mild: treat like you would a sunburn.Moderate to Severe:May require prednisone (steroids).Pain medicationRemove offending agent (if not a required medication)Stay out of the sunUse sunblock frequently and generously.Read the label on all medications and check manufacturer websites.
57Sun Poisoning Severe reaction after intense sun exposure. Fever & ChillsHeadacheNausea & VomitingDehydration and may experience altered mental status if the blood pressure fallsTreatment is the same as heat exhaustion with the addition of prednisone for the most severe reactions.
58Drugs that Cause Photosensitivity Reactions Antibiotics:CyclinesFlouroquinolones (Cipro, Levaquin, Avelox)Bactrim/SulfonamidesNalidixic AcidAntihistaminesAntiparasiticsAntihypertensivesCaptoprilDiltiazemNifedipine
59Drugs that Cause Photosensitivity Reactions Anti-InflammatoryMotrin/IbuprophenIndocinNaprosynPiroxicanm (Feldene)DiureticsDiamoxHCTZLasix/FurosemideTrimaterene (Maxzide)MiscellaneousBenzocineBenzoyl PeroxideOCPTopical CortisoneAmiodaroneXanaxRetin-A/AccutaneHypoglycemicsGlipizideGlyburideTolbutamide (Orinase)
60Sunscreens that Cause Photosensitivity Preps containing the following:Aminobenzoic AcidAvobenzoneBenzophenonesCinnamatesHomosalateMethyl AnthranilatePABA Esters
61Treatment of SunburnCool wet compresses for 15 to 20 minutes every hour.Frequent cool showers or duse with cold sea water.Pain medication (Ibuprophen, narcotic analgesics).Topical aloe vera gel for comfort and healing.Antibacterial OintmentLidocaine jelly or anesthetic sunburn spray.Leave blisters intact as your own body fluid & skin are a natural barrier and promote healing.
62Perfumes, Lotions and Cosmetics that Cause Photosensitivity Bergamot OilOil of Citron, Lavendar, Cedar, Lime, Sandalwood, Citrus Rind Oils and 6-methylcoumarinHexachlorophene (Phisohex, etc.)
63Trauma 101 Sprains, strains, fractures, contusions, dislocations….. All bets are off out to sea!Chest and head trauma are the most common injuries for recreational boaters.Head Injuries include both blunt and penetrating trauma.Chest injuries include both blunt and penetrating trauma
64Head InjuriesFalls, hit in the head with flying objects and naturally the “boom” .Cuts to the face and scalp.Blunt trauma to facial bones.Nose bleeds secondary to facial trauma.
66What to look for with a head injury Was there a loss of consciousness (+LOC)?Is amnesia present?Do they have normal speech, mentation and are they moving all extrmities?Is there a complaint of numbness or tingling in an arm or leg?Is there nausea/vomiting?Is there a complaint of blurry vision?
69Treatment of Head Injuries If there is neurological abnormality - immediate evacuation with emergency medical attention.Prolonged loss of consciousnessNumb/Tingle in extremities or an inabilty to use an extremity without signs of a broken boneRemember to try and immobilize the neck
70Treatment of Head Injuries If there is a brief LOC then it may be safe to remain onboard and observe carefully for the next 24 hours.Signs of a more severe injury include:Nausea/VomitingVision ChangesDizzinessChange in speechChange in mentation
71Chest Injuries Most are from blunt force: Can cause rib fractures. If ribs are fractured then make sure the injured person can breath comfortably as they are at risk of puncturing their lung from a broken rib.
73Examination of the Chest Wall Expose the area to look for any open wounds.Feel along the chest wall front and back to see if there are “rice crispies”.Feel the breast bone for tenderness.Look for any deformity of the collar bones.Watch the breathing pattern - is it regular or short and gasping?
74Treatment of Chest Injuries Pain medication.Ice bruised areas found when you examine the chest.Duck tape???Monitor for any changes in breathing and pain increase with inspiration (taking a breath).
75Sprains, Strains, Fractures & Dislocations RICE: rest, ice, compression and elevation.Pain MedicationIf a bone appears deformed - splint in anatomically and place in a position of comfort.If severe deformity then medical attention is required.Blood loss can happen with long bone fractures.Nerve injuries can occur with dislocations and fractures - if not treated in a timely manner.Not sure then summon help.
80Marine Evenomation The Jellyfish Sting Reactions vary b the type of jelly fish, venom potency and the amount injected.Symptoms vary from burning to itching to excruciating pain.Anaphylaxis with difficulty breathing, drop in blood pressure and shock.
81Treatment of Jellyfish Sting Apply vinegar (Acetic Acid 5%) immediately to inactivate the venom.If vinegar is not available use sea water.NEVER rinse with fresh water or apply ice directly to the skin as it will activate stinging cells and increase pain/reaction.If eyes are involved irrigate immediately with saline or sea water.
82Treatment of Jellyfish Sting Rubbing alcohol and vinegar can help with pain over the first hour.Baking soda paste provides relief.1/4 strength household ammonia may help.Limited usefulness of meat tenderizer.Remove embedded particles or tentacles with a tweezer. Wear protective gloves. You can also apply shave cream and shave the skin gently.Hydrocortisone CreamPrednisone and BenedrylIf stung on the mouth - watch for swelling.
83Wound Care All bleeding stops with pressure. Apply direct pressure over the wound for 15 minutes and elevate the affected body part.Neck wounds - pinch the area instead of pressure.
86Wound CareClean wounds with saline or fresh water kept onboard specifically for wound care (boiled and stored).Alcohol and Hydrogen Peroxide applied full strength can be toxic to tissues.“If you can’t put it in your eye then don’t put it in your wounds”.Other wound care information
87Methods of Wound Closure BandaidButterfly BandaidSteristripsOcclusive DressingSkin GlueStaples (surgical staples)Sutures
88Checking the WoundMonitor carefully for signs of infection and age appropriate healing.Pus draining from woundPain, redness and swellingFever and ChillsSwollen tender lymph nodesRed streaking in the affected area
89Choosing Your Medical Kit Based on how far you will travel and your health history.Easy to stow and easily accessible to all onboard.Basic supplies versus advanced medical kit