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