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MEDICAL EMERGENCIES ON BOARD ΙΑΤΡΙΚΗ ΣΤΗ ΘΑΛΑΣΣΑ 3ο ΣΥΝΕΔΡΙΟ ΝΑΥΤΙΚΗΣ- ΤΑΞΙΔΙΩΤΙΚΗΣ ΙΑΤΡΙΚΗΣ ΙΔΡΥΜΑ Α MEDICAL EMERGENCIES ON BOARD ΙΑΤΡΙΚΗ ΣΤΗ ΘΑΛΑΣΣΑ 3ο ΣΥΝΕΔΡΙΟ ΝΑΥΤΙΚΗΣ- ΤΑΞΙΔΙΩΤΙΚΗΣ ΙΑΤΡΙΚΗΣ ΙΔΡΥΜΑ Α ΛΑΣΚΑΡΙΔΗ 2 -3 ΔΕΚ 2011 CDR VASILIS BEKOS, HN ANAESTHESIOLOGIST-INTENSIVIST ATHENS NAVAL HOSPITAL ICU DIRECTOR

MEDICAL EMERGENCIES Vasovagal syncope l Cardiac emergencies l Neurological emergencies l Respiratory emergencies l MEDICAL EMERGENCIES Vasovagal syncope l Cardiac emergencies l Neurological emergencies l Respiratory emergencies l Gastrointestinal emergencies l Dizziness-Nausea-Vertigo-Seizures l

MEDICAL EMERGENCIES l l l Vasovagal syncope Cardiac emergencies Neurological emergencies Respiratory emergencies Gastrointestinal MEDICAL EMERGENCIES l l l Vasovagal syncope Cardiac emergencies Neurological emergencies Respiratory emergencies Gastrointestinal emergencies Dizziness-Nausea-Vertigo-Seizures MOST EVENTS ARE NOT SERIOUS MEDICAL EVACUATION < 7 -14%

MEDICAL INTERVENTIONS Medical staff (physician-nurse) l Environment (special) l Emergency facilities l Triage l MEDICAL INTERVENTIONS Medical staff (physician-nurse) l Environment (special) l Emergency facilities l Triage l

MEDICAL INTERVENTIONS l A - airway l B - breathing l C - circulation MEDICAL INTERVENTIONS l A - airway l B - breathing l C - circulation

Cardiac events on board… l l l Ischemic heart disease…on earth Increasing number of Cardiac events on board… l l l Ischemic heart disease…on earth Increasing number of travelers Elderly passengers Longer distances Acute environmental conditions

Open Airway Look for signs of life l l …. to confirm cardiac arrest Open Airway Look for signs of life l l …. to confirm cardiac arrest Pulse check if trained to do so Take no more than 10 seconds for assessment

A-airway MEDICAL INTERVENTIONS l Supraglotic devices Trachea intubation l Emergency cricothyroidotomy l A-airway MEDICAL INTERVENTIONS l Supraglotic devices Trachea intubation l Emergency cricothyroidotomy l

A-airway MEDICAL INTERVENTIONS A-airway MEDICAL INTERVENTIONS

A-airway Cricothyroidotomy l l Only as a last chance to achieve airway For an A-airway Cricothyroidotomy l l Only as a last chance to achieve airway For an upper airway obstruction…above the larynx Safer and quicker that tracheostomy Cricothyroidotomy emergency kit

B- breathing MEDICAL INTERVENTIONS Mechanical ventilation l Needle thoracentesis l Chest tube placement l B- breathing MEDICAL INTERVENTIONS Mechanical ventilation l Needle thoracentesis l Chest tube placement l

B- breathing Mechanical ventilation Ventilator (mechanical) – bag valve vent l Secure airway (LMA-intubation) B- breathing Mechanical ventilation Ventilator (mechanical) – bag valve vent l Secure airway (LMA-intubation) l Sedation l Mechanical ventilation parameters: l frequency-oxygen inspiration fraction-inspiration pressure / tidal volume-PEEP

B- breathing Chest tube placement l Hemothorax-pneumothorax l Needle thoracentesis (hypotensiondecreased or absent breath B- breathing Chest tube placement l Hemothorax-pneumothorax l Needle thoracentesis (hypotensiondecreased or absent breath sounds to one side) l Emergency kit (Heimlich valve)

C- circulation MEDICAL INTERVENTIONS CPR l Defibrillation / Cardioversion l l Temporary cardiac pacing C- circulation MEDICAL INTERVENTIONS CPR l Defibrillation / Cardioversion l l Temporary cardiac pacing Central vein cannulation Vein cutdown

Chest compression l l 30: 2 Compressions l “Centre of chest” l 4 -5 Chest compression l l 30: 2 Compressions l “Centre of chest” l 4 -5 cm depth l 100 min-1 Uninterrupted compressions when airway secured Avoid l Provider fatigue l Interruptions

Self-adhesive electrodes l l Hands-free Remove excess chest hair Dry chest if necessary Continue Self-adhesive electrodes l l Hands-free Remove excess chest hair Dry chest if necessary Continue CPR whilst applying

Shockable (VF) • Bizarre irregular waveform • No recognisable QRS complexes • Random frequency Shockable (VF) • Bizarre irregular waveform • No recognisable QRS complexes • Random frequency and amplitude • Uncoordinated electrical activity • Coarse / fine • Exclude artefact – movement – electrical interference

Shockable (VT) • Monomorphic VT – broad complex rhythm – rapid rate – constant Shockable (VT) • Monomorphic VT – broad complex rhythm – rapid rate – constant QRS morphology

Non-shockable Asystole • Absent ventricular (QRS) activity • Atrial activity (P waves) may persist Non-shockable Asystole • Absent ventricular (QRS) activity • Atrial activity (P waves) may persist • Rarely a straight line trace

Non-shockable (PEA) • Clinical features of cardiac arrest • ECG normally associated with an Non-shockable (PEA) • Clinical features of cardiac arrest • ECG normally associated with an output

CPR… to buy time!!! l l BLS keep brain alive. . Until an AED CPR… to buy time!!! l l BLS keep brain alive. . Until an AED used

…more MEDICAL INTERVENTIONS l Urinary catheter l Nasogastric tube l Anti Epileptic l Bronchodilations …more MEDICAL INTERVENTIONS l Urinary catheter l Nasogastric tube l Anti Epileptic l Bronchodilations l. Analgesia- Sedation

SUMMARY l. Ischemic heart disease is a leading cause of death l. Importance of SUMMARY l. Ischemic heart disease is a leading cause of death l. Importance of clinical signs early recognition and prevention of a cardiac arrest event l. Following the ALS algorithm l. Early air-evacuation l. Post Resuscitation Care l Similar with the intervention on land