twistedtree
Guru
Just out of curiosity, does anyone know the differences between Wilderness First Responder training and STCW medical training? I'm heading off in a few weeks for an STCW refresher which is now required every 5 years.
Also taking a baby aspirin may save your life.This comes from Dr. Patrick Teefy, Cardiology Head at the Nuclear Medicine Institute, University Hospital, London, Ont.
1. Let's say it's 7:25 p.m. and you're going home home, alone of course, after an unusually hard day on the job.
2. You're really tired, upset and frustrated.
3. Suddenly you start experiencing a severe pain in your chest that starts to drag out into your arm and up into your jaw. You are only a couple miles from the hospital nearest you.
4. Unfortunately you don't know if you'll be able to make it that far.
5. You have been trained in CPR but the guy that taught the course did not tell you how to perform it on yourself.
6. HOW TO SURVIVE A HEART ATTACK WHEN ALONE.
Since many people are alone when they suffer a heart attack without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.
7. However, these victims can help themselves by coughing repeatedly and very vigorously.
A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest.
A breath and a cough must be repeated about every two seconds without letup until help arrives, or until the heart is felt to be beating normally again.
8. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it to regain a normal rhythm.
In this way, heart attack victims can get help or to a hospital.
9. Tell as many other people as possible about this. It could save their lives!
Just out of curiosity, does anyone know the differences between Wilderness First Responder training and STCW medical training? I'm heading off in a few weeks for an STCW refresher which is now required every 5 years.
I am a retired Intensive Care Doctor in the UK. Some of what has been said is good sense and I'm afraid some is nonsense. I am not going to get into that argument.
What I would say is that if you have someone on your boat who is ill, for whatever the reason, please can you write down the time and date with a history. I have prepared an observation chart for people who have an immersion injury (fallen overboard) along with instructions on how to do simple basic observations that may prove invaluable when they get to hospital. Please put these in a waterproof (I think the American word is fanny pack) bag strapped to the crew members waist.
Also put in the bag any drugs they are on. A mobile phone, credit card, some cash and a contacts business card is also invaluable.
If you are abroad then a passport and medical insurance certificate (or at least copies of them) are invaluable. In the US as I understand it a medical insurance certificate might also be useful (in the UK health care is free at the point of delivery).
So many times I've been faced with patients who I barely know the name of, let alone what drugs they are on and exactly what and when the event happened.
Some people don't want to give that info. My work around was to ask them to put it in a sealed envelope only to be opened in a medical emergency if they are unresponsive. The envelope to be returned to them when they disembark unopened if not needed.Another medical professional emphasizing the need for information. I felt strange asking friends to fill out medical histories on friends and family, but in doing so it became obvious that whether on board or elsewhere, this was critical information in the event of any medical issues.
Having some training and more experience than I want, I can confirm that cardiac arrest can and usually does strike without warning. If you heart stops while alone, you're done, cooked, get the fork. March 17, 2020 I went to sleep and didn't wake up, my wife had the presence of mind, and divine guidance, to call 911 and begin CPR. 9 minutes later the squad arrived and hit me with a AED. Prior to this, my BP was within normal range, cholesterol was not a concern, I carried a few unnecessary pounds but the physical I had 3 weeks prior was as routine and brushing one's teeth. If you are "lucky" enough to go thru a similar experience, your best hope is having someone close by who knows CPR or has fast access to an AED. That will save your life. Having an AED on your boat is expensive but could prove useful.
In my case, my wife had not been trained, but Someone gave her guidance. I had run with the local fire and rescue squad, apparently it was like a family reunion that night, complete with deputies. I "slept" thru it all. In fact due to a chart mix up later that night, (I was thought to be 6'4" and 240 lbs, actually 5'6" about 190 at the time) I was administered a bit too much propafol and didn't wake up for a month. March 2020 was the onset of COVID so I can understand the ER resembling a MASH unit.
My family has a number of MD’s including an gerontologist and an emergency room physician. I had sent them all a screen shot of the posting and this proves the point of “Don’t Believe What’s on the Internet”. I will attach the two screen shots they sent me and as he said—read the note the quoted doctor put as a disclaimer-file:///var/mobile/Library/SMS/Attachments/63/03/335A91C9-AD48-4EFE-A6CD-DCF011A64741/IMG_8064.jpeg
Hmm. The actual seems to be a link—but have a look at both
file:///var/mobile/Library/SMS/Attachments/dc/12/6FF444C0-532A-473C-AF64-3E424E59F2ED/IMG_8065.jpeg
If you can’t—the gist is he is a Belarusian trained cardiologist (good so far) he denounces and reference to Cough Therapy and any connection to himself.
There are also other situations were decreasing preload would not be advantageous.
In basic concept, the heart is comprised of four chambers, two atria (singular = atrium) and two ventricles, one of each being “right” and the other of each one being “left”, which simultaneously pump blood through two circuits. The right heart consists of the right atrium, which receives all venous blood returning from the body. The right atrium pumps blood into the larger right ventricle. The right ventricle then pumps the blood out and into the lungs where it is oxygenated. The left atrium receives the oxygenated blood coming through the lungs. The left atrium pumps the blood into the left ventricle which is the largest and strongest of the four pumping chambers. The left ventricle pumps the oxygen rich blood, at high pressure, out into the body. In the body, crucial organs like the brain, kidneys and liver, AND HEART extract the oxygen from the blood. The venous system then collects all of the blood, which has now had the oxygen extracted, and returns it to the right atrium to repeat the cycle. Failure of any one of the four pumping chambers (right atrium, right ventricle, left atrium, left ventricle) can impair delivery of oxygenated blood to the vital organs. A heart attack occurs when blood supply is interrupted, or impeded, to a portion of the heart. The left ventricle is the largest, strongest, and most critical. Most heart attacks strike the “left heart” and not surprisingly sudden death is often the first symptom. These pumping chambers are akin to the diaphragm , as opposed to centrifugal, pumps we have aboard boats. If we are trying to pressurize a closed loop system ( think fresh-water cooling) one important consideration is keeping the loop full of the substance being circulated. Muscle fibers, think cardiac muscle fibers, contract more forcefully if they are somewhat stretched before they actually contract ( think of that diaphragm bilge pump that works best when the bellows are completely full). This is up to a point at which the fibers are over-stretched and begin to fail (in congestive heart failure “CHF” fluid has backed up and the heart chambers are overstretched to the point where the heart muscle cells begin to fail). PRELOAD is the term for the pressure generated by the venous blood returning from the body to the right atrium. To a point the pump function of the right atrium increases as the filling pressure (PRELOAD) increases. This is important to insure adequate blood delivery to the right ventricle, lungs and left heart. With traumatic hemorrhage there is not enough blood return, not enough preload, to keep even a normal heart pumping adequately … the pump circuit is empty. With a right side heart attack, the struggling right atrium and right ventricle may benefit from slightly increased preload … e.g. an IV bolus of fluid, or a position (legs up) which increases the return of venous blood to the heart. Nitroglycerin (NTG) is a powerful vasodilator, it relaxes the muscle cells within the walls of arteries and veins. This can allow increased blood flow through the (coronary) arteries supplying the heart which which is beneficial during a heart attack, especially a left-sided heart attack. Alternatively, during a right-sided heart attack, NTG can dilate the veins returning blood to the right atrium, increasing their capacity and decreasing blood return (decreasing preload) which might detrimentally further impair an already struggling right heart.
Outstanding explanation thank you Sir
Thank you so much for explaining preload. My intention was to point out how you could violate “first do no harm”. In my mind this extends to many non cardiac events. Will offer a few examples.
On screening you try your best to exclude any functional alcoholic from crew but fail. You run a dry ship on passage except for a rare wine or shot at dinner. One crew fails to come up for watch. He’s unconscious. You know he carries nitro and has a past history of CAD (coronary artery disease) but his doc has cleared him for the trip as he had cabg (coronary artery bypass grafts) awhile ago and has been asymptomatic.
You think about putting a nitro under his tongue. But do a careful exam first. You see faint nystagmus (flickers of eyeball jerks) to the left. Assume he’s in non convulsive status epilepticus. There’s a increased incidence of epilepsy in folks with a history of substance abuse disorders including alcohol. What happened was he was withdrawing which precipitated convulsive status. He had been seizing long enough he entered non convulsive status. In this setting you can’t deliver enough oxygen to the brain as to prevent anoxic encephalopathy. You want the highest perfusion pressures you can get. You want the highest oxygen levels you can get. Giving nitro will lower preload and thereby perfusion. You will be contributing to brain cell death by slipping that nitro under his tongue.
Same guy. He hid a bunch of nips in his sea bag. He banged his head and developed a SDH (subdural hematoma). Again find him in his berth. Left fist clenched across his chest. Again decreasing preload and blood pressure which will decrease perfusion to his compressed hemisphere and related structures and increase damage.
Same guy. Now stuporous but complaining of chest pain. Unbeknownst to you is he has pending cardiac tamponade from a bleed between the covering of his heart and the outside of his heart. There’s nothing wrong with his heart but rather he has low platelets from his drinking.
Could go on and on but point being there’s lots of scenarios where you might think the problem is cardiac ischemia (heart attack) but it isn’t and giving nitro would make things worse not better. That’s why my wife and I (and B) know what we don’t know so don’t intervene without consulting with others. We have made plans so we can achieve that. Only intervene when we’re confident in our thinking or have no other choice due to the urgency of the situation.
Paddles are expensive. Ambu bags aren’t. Learn some first provider medicine.
Over the years the multi-pronged complicated algorithm taught to physicians and EMS responders for treating a cardiac arrest (or imminent arrest) patient have been extremely simplified and contracted … because almost nothing really increased the likelihood of discharge to home after a cardiac arrest. The discouraging reality. Now it is recognized that the most important factors are early effective CPR and early defibrillation with an AED (Automatic External Defibrillator) … way more important than any medications. Everyone should learn how to render effective CPR, it is not complicated or difficult. Also, AED’s are ubiquitous … at least on shore … and they are not complicated or difficult. So back to the original thread: I’m afraid that if you have a cardiac event, while alone, significant enough to incapacitate you … well, I think your time has come.
WOW! This thread has so many opinions its like watching HOUSE on TV!
Yes, and Dr. House (oh a show from the past) but Dr. House, always guessed wrong the first time.