MEDICAL EMERGENCIES MEDICAL EMERGENCIES ON BOARDON BOARD

ΙΑΤΡΙΚΗ ΣΤΗ ΘΑΛΑΣΣΑΙΑΤΡΙΚΗ ΣΤΗ ΘΑΛΑΣΣΑ33οο ΣΥΝΕΔΡΙΟΣΥΝΕΔΡΙΟ ΝΑΥΤΙΚΗΣΝΑΥΤΙΚΗΣ-- ΤΑΞΙΔΙΩΤΙΚΗΣΤΑΞΙΔΙΩΤΙΚΗΣ ΙΑΤΡΙΚΗΣΙΑΤΡΙΚΗΣ

ΙΔΡΥΜΑ Α ΛΑΣΚΑΡΙΔΗ ΙΔΡΥΜΑ Α ΛΑΣΚΑΡΙΔΗ 2-3 ΔΕΚ 2011 2-3 ΔΕΚ 2011

CDR VASILIS BEKOS, HNCDR VASILIS BEKOS, HNANAESTHESIOLOGIST-INTENSIVISTANAESTHESIOLOGIST-INTENSIVIST

ATHENS NAVAL HOSPITAL ICU DIRECTORATHENS NAVAL HOSPITAL ICU DIRECTOR

MEDICAL EMERGENCIESMEDICAL EMERGENCIES

Vasovagal syncopeVasovagal syncopeCardiac emergenciesCardiac emergenciesNeurological emergenciesNeurological emergenciesRespiratory emergenciesRespiratory emergenciesGastrointestinal emergenciesGastrointestinal emergenciesDizziness-Nausea-Vertigo-SeizuresDizziness-Nausea-Vertigo-Seizures

MEDICAL EMERGENCIESMEDICAL EMERGENCIES

Vasovagal syncopeVasovagal syncope Cardiac emergenciesCardiac emergencies Neurological emergenciesNeurological emergencies Respiratory emergenciesRespiratory emergencies Gastrointestinal emergenciesGastrointestinal emergencies Dizziness-Nausea-Vertigo-SeizuresDizziness-Nausea-Vertigo-Seizures

MOST EVENTS ARE NOT SERIOUSMOST EVENTS ARE NOT SERIOUSMEDICAL EVACUATION < 7-14% MEDICAL EVACUATION < 7-14%

MEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

Medical staff (physician-nurse)Medical staff (physician-nurse)Environment (special)Environment (special)Emergency facilitiesEmergency facilitiesTriage Triage

MEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

AA - airway - airway

B B - breathing- breathing

CC - circulation - circulation

Cardiac events on board…Cardiac events on board…

Ischemic heart disease…on earthIschemic heart disease…on earth Increasing number of travelersIncreasing number of travelers Elderly passengersElderly passengers Longer distancesLonger distances Acute environmental conditions Acute environmental conditions

……. to confirm cardiac arrest. to confirm cardiac arrest

Pulse check if Pulse check if trained to do sotrained to do so

Take no more than Take no more than 10 seconds for 10 seconds for assessment assessment

Open Airway Look for signs of life

A-airwayA-airwayMEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

Supraglotic devicesSupraglotic devices

Trachea intubationTrachea intubationEmergency cricothyroidotomyEmergency cricothyroidotomy

A-airwayA-airwayMEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

A-airwayA-airway

CricothyroidotomyCricothyroidotomy

Only as a last chance to achieve airwayOnly as a last chance to achieve airway For an upper airway obstruction…above the For an upper airway obstruction…above the

larynxlarynx Safer and quicker that tracheostomySafer and quicker that tracheostomy Cricothyroidotomy emergency kitCricothyroidotomy emergency kit

B- breathingB- breathingMEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

Mechanical ventilationMechanical ventilationNeedle thoracentesis Needle thoracentesis Chest tube placementChest tube placement

B- breathingB- breathing

Mechanical ventilationMechanical ventilation

Ventilator Ventilator (mechanical)(mechanical) – bag valve vent – bag valve vent Secure airway (LMA-intubation)Secure airway (LMA-intubation)SedationSedationMechanical ventilation parameters: Mechanical ventilation parameters:

frequency-oxygen inspiration fraction-inspiration frequency-oxygen inspiration fraction-inspiration pressure / tidal volume-PEEPpressure / tidal volume-PEEP

B- breathingB- breathing

Chest tube placementChest tube placement

Hemothorax-pneumothoraxHemothorax-pneumothorax

Needle thoracentesisNeedle thoracentesis (hypotension- (hypotension-decreased or absent breath sounds to one decreased or absent breath sounds to one side)side)

Emergency kit (Heimlich valve)Emergency kit (Heimlich valve)

C- circulationC- circulationMEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

CPRCPRDefibrillation / CardioversionDefibrillation / Cardioversion

Temporary cardiac pacingTemporary cardiac pacing Central vein cannulationCentral vein cannulation Vein cutdownVein cutdown

Chest compressionChest compression

30:2 30:2 CompressionsCompressions

““Centre of chest”Centre of chest”4-5 cm depth4-5 cm depth100 min100 min-1-1

Uninterrupted Uninterrupted compressions when compressions when airway securedairway secured

AvoidAvoidProvider fatigueProvider fatigue InterruptionsInterruptions

Self-adhesive electrodesSelf-adhesive electrodes

Hands-free Hands-free Remove excess Remove excess

chest hairchest hair Dry chest if Dry chest if

necessarynecessary Continue CPR whilst Continue CPR whilst

applyingapplying

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 QRS morphology

Non-shockableAsystole

• 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 output

CPR… to buy time!!!CPR… to buy time!!! BLS keep BLS keep

brain brain alive....alive....

Until an Until an AED usedAED used

……moremoreMEDICAL INTERVENTIONSMEDICAL INTERVENTIONS

Urinary catheterUrinary catheterNasogastric tubeNasogastric tubeAnti Epileptic Anti Epileptic Bronchodilations Bronchodilations

Analgesia- SedationAnalgesia- Sedation

SUMMARYSUMMARY

Ischemic heart disease is a leading Ischemic heart disease is a leading cause of deathcause of death

Importance of clinical signs early Importance of clinical signs early recognition and prevention of a cardiac recognition and prevention of a cardiac arrest eventarrest event

Following the ALS algorithmFollowing the ALS algorithmEarly air-evacuation Early air-evacuation Post Resuscitation CarePost Resuscitation Care Similar with the intervention on landSimilar with the intervention on land