Medical Support Offshore Elementary First Aid Core Medical Training Course

1. Medical Support Offshore Elementary First Aid Core Medical Training Course

2. Basic Patient Assessment

3. Basic Patient Assessment

4. Basic Patient Assessment

5. Basic Patient Assessment

6. Basic Patient Assessment

7. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin

8. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s)

9. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc

10. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc Previous medical history Previous operations Serious accidents Specific medical complaints High blood pressure, heart disease, kidney disease, jaundice, TB, diabetes, epilepsy, asthma

11. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc Previous medical history Previous operations Serious accidents Specific medical complaints High blood pressure, heart disease, kidney disease, jaundice, TB, diabetes, epilepsy, asthma Normal medications

12. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc Previous medical history Previous operations Serious accidents Specific medical complaints High blood pressure, heart disease, kidney disease, jaundice, TB, diabetes, epilepsy, asthma Normal medications Allergies Drugs, food or environmental Type of reaction (rash, collapse, loss of airway)

13. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc Previous medical history Previous operations Serious accidents Specific medical complaints High blood pressure, heart disease, kidney disease, jaundice, TB, diabetes, epilepsy, asthma Normal medications Allergies Drugs, food or environmental Type of reaction (rash, collapse, loss of airway) History of illnesses in the family Heart disease, diabetes, any other significant diseases

14. Basic Patient Assessment Casualty details Date, time and place Name Date of birth Next of kin Main Complaint (s) Identify the most important problem(s) Details of main complaint When last well Details of symptoms such as pain Timings of onset etc Previous medical history Previous operations Serious accidents Specific medical complaints High blood pressure, heart disease, kidney disease, jaundice, TB, diabetes, epilepsy, asthma Normal medications Allergies Drugs, food or environmental Type of reaction (rash, collapse, loss of airway) History of illnesses in the family Heart disease, diabetes, any other significant diseases Direct questions about body symptoms

15. Basic Patient Assessment Look • Make sure the area is well lit, and you can see a reasonable amount of the casualty • General appearance - well or unwell • Skin colour, rashes • Obvious injury: Deformity • Wounds • Blood or fluid from orifices

16. Basic Patient Assessment Look • Make sure the area is well lit, and you can see a reasonable amount of the casualty • General appearance - well or unwell • Skin colour, rashes • Obvious injury: Deformity • Wounds • Blood or fluid from orifices Feel • Try not to cause pain • Comfortable, stable position for the casualty and you • Warm, firm but gentle hands • Look for: Tenderness • Broken bones (GENTLY) • Pulses

17. Basic Patient Assessment Look • Make sure the area is well lit, and you can see a reasonable amount of the casualty • General appearance - well or unwell • Skin colour, rashes • Obvious injury: Deformity • Wounds • Blood or fluid from orifices Feel • Try not to cause pain • Comfortable, stable position for the casualty and you • Warm, firm but gentle hands • Look for: Tenderness • Broken bones (GENTLY) • Pulses Listen • Breathing sounds: Noisy / silent • On inspiration / expiration • Voice – has it changed in any way? • With a stethoscope: • Chest: Silent (no breath sounds) • Wheeze (on expiration) • Harsh (on inspiration and expiration) • Abdomen: Sounds of gas moving in the bowel (bowel sounds)

18. Basic Patient Assessment Look • Make sure the area is well lit, and you can see a reasonable amount of the casualty • General appearance - well or unwell • Skin colour, rashes • Obvious injury: Deformity • Wounds • Blood or fluid from orifices Feel • Try not to cause pain • Comfortable, stable position for the casualty and you • Warm, firm but gentle hands • Look for: Tenderness • Broken bones (GENTLY) • Pulses Listen • Breathing sounds: Noisy / silent • On inspiration / expiration • Voice – has it changed in any way? • With a stethoscope: • Chest: Silent (no breath sounds) • Wheeze (on expiration) • Harsh (on inspiration and expiration) • Abdomen: Sounds of gas moving in the bowel (bowel sounds) • Ask the casualty to move the limb first • Move the limb yourself very carefully • Look for range of movement of joints • Is movement limited by pain or mechanical locking? Move

19. Basic Patient Assessment

20. Basic Patient Assessment Testing

21. Basic Patient Assessment Record keeping It is of paramount importance that details of the history and examination are kept as you go along. Facts and figures are very easily forgotten, and the medical record may well be of considerable importance for the shore medical team.

22. Questions?

23. Clinical Shock

24. Definition of shock ‘Shock is a condition in which there is insufficient blood pressure or blood flow to perfuse vital organs causing the classic signs of shock’

25. Types of shock • Hypovolaemia: loss of blood/fluid • Septicaemia: overwhelming infection • Anaphylaxis: severe allergy • Neurogenic: spinal injury • Cold shock: immersion • Electric Shock: AC/DC & lightning

26. Pale, cold, blue (cyanosis ) or clammy Rapid shallow respirations Fast weak pulse Capillary refill test – longer than 2 secs Listless, restless, aggressive Vomiting Thirsty with low urine output Unconsciousness Signs of shock

27. If unresponsive, Airway, Breathing, Circulation If conscious, give oxygen 5 litres/min Treat the cause (bleeding/fractures) Place in shock position Consider intravenous fluids if BP low Reassure and keep warm Call for help Treatment of shock

28. Cause Severe Allergy eg stings, food and drugs Treatment If unresponsive, Airway, Breathing, Circulation Administer adrenaline urgently (0.5mls 1:1000 or EpiPen) Watch airway – may become swollen, with breathing difficulty – give oxygen if available Shock position if appears pale/shocked Hydrocortisone 100mg im or iv Antihistamines oral or im Salbutamol/Steroid inhaler Consider intravenous fluids if low blood pressure Anaphylactic shock

29. Allergic reaction • Itchy skin and eyes • Red rash, wheals, hives • Runny nose Simple allergic reaction Worsening reaction • General skin flushing • Swelling of lips and eyes • Fast pulse • Faintness • Wheezy chest • Shock Watch airway • Swollen tongue • Throat constriction • Short of breath Treatment • Remove cause • Anti-histamine Piriton 4mg orally 3 times daily for three days • Seek medical advice if it re-occurs Collapsed? Anaphylaxis Resuscitate ABC Oxygen Lie down, legs up Immediate treatment • Adrenaline 0.5mg im (0.5ml of 1:1000 solution) Repeat adrenaline injection every 5-10 minutes if not improving Further treatment • Anti-histamine: Chlorphenamine 10-20mg im • Steroid: Hydrocortisone 100mg im or iv • Inhaler: Salbutamol 4 puffs. Repeat every five mins of needed On-going treatment • Insert an iv cannula • Intravenous fluids if blood pressure low • Prednisolone 20mg daily orally • Chlorphenamine 4mg 3 times daily orally Seek medical advice early

30. Questions?

32. Assessing Trauma

33. Assessing Trauma Primary Survey Take care of risks Avoid causing morecasualties Approach Assess Is the crewman responsive or unconscious? Airway Is the airway is open or blocked? Is there a risk to the CSpine – protect if any doubt Is the crewman breathing? Is breathing adequate? Breathing Circulation Does the crewman have a pulse? Is the circulation adequate? Disability What is the level of consciousness? Environment Protect the crewman from the environment and further injury

34. Assessing Trauma • Approaching the injured crewman – Don’t become a casualty yourself • Clear obstacles (e.g. swinging broken mast) • Avoid electrical cables, gas etc. • Wear protective equipment • Level the yacht Assessing the crewman - Find out whether he is responsive or unconscious. • Assess • Speak loudly in his ear • Shake gently by the shoulder • Action • If he responds normally, he: • has an airway • is breathing • has enough circulation to perfuse his brain • Keep comfortable, safe and go to secondary survey

35. Assessing Trauma Airway and CSpine protection • Assess • Unconscious • Distress • Seesaw chest • Noisy breathing • Obvious effort on inspiration • Injury to mouth/face/neck • Action • Stabilise the CSpine if any history of injury to head or neck • Open airway using ‘head tilt’/ ‘chin lift’ • Look in the mouth for obvious objects that may be obstructing • Use an artificial airway if available Breathing • Assess • Crewman blue or pale? • Chest moving up and down? • Breathing rapid & shallow? • Obvious injury to the chest that requires immediate attention? • Measure rate of breathing • Action • Start BLS if not breathing • Give oxygen if breathing • Keep the airway open • Put in the recovery position or sit up if this helps • Treat a pneumothorax if possible • Keep warm

36. Assessing Trauma Circulation and control of bleeding • Assess • Confused or anxious? • Cold, sweaty and shut down around the edges? • Obvious bleeding? • Measure pulse rate & blood pressure • Action • Start BLS if no pulse • Place crewman horizontal, legs in air • Control bleeding • Insert a cannula in to a vein • Give intravenous fluids if available • Keep warm Disability • Assess • Level of consciousness? • A - Alert • V - responds to Voice • P - responds to Pain • U - Unresponsive • Are the pupils equal and responding to light? • Action • If reduced conscious level and breathing, place in recovery position • Continue to treat other problems • Reassess frequently • Keep warm

37. Assessing Trauma Environment – protect the crewman whilst he is exposed for examination • Assess • Increasingly cool and mottled skin • Shivering • Low temperature • Action • Keep exposure time to a minimum whilst still examining thoroughly • Remove the crewman from the exposed deck as soon as possible • When stable, get the crewman below and get him warm and dry

38. Assessing Trauma Secondary Survey • Allergies These are common, especially to some antibiotics, and can be life threatening, making a bad situation worse. • Medication What does the crewman normally take? Some medications may confuse the situation, causing symptoms in their own right. • Past illnesses On-going medical complaints such as diabetes may have considerable impact on the current problem. The list of medications being taken often gives a clue to past illnesses. • Last meal Time of the last meal gives an indication whether the stomach may be full, which increases the chance of vomiting, especially if unconscious. • Events Finding out exactly what happened, and when it happened, gives a good idea about the possible injuries that may be expected. A fall from the spreaders will probably lead to more serious injuries than a fall in to the cockpit. Try to establish: • What happened • Where did it happen • When did it happen • How did it happen • Why did it happen (for future prevention)

39. Assessing Trauma • Look for: • Medic alert bracelets, necklaces • Old operation scars • In pockets for medications Secondary Survey Head, face, eyes, ears, nose, mouth, neck Lacerations, clear fluid (CSF), blood, deformity, pupils & eye movements Chest (front and back) Breathing depth and rate, trachea central, deformity, wounds (penetrating), noisy breathing, breath sounds, tenderness Abdomen (front and back) Distension, wounds (penetrating), bruising, rigidity, tenderness, bowel sounds Spine (from the back on log roll) Obvious distortion, bruising, sensation, tenderness (run the fingers along the spine) Pelvis (front and back) Obvious distortion, bruising, tenderness, spring test genitalia (bleeding, discharge, incontinence) Arms and legs Deformity, lacerations, bruising, tenderness, movement (joints), power, sensation (look beyond any fracture to make sure blood and nerve supply intact)

40. Questions?

42. Life-Saving Manoeuvres

43. Life-Saving Manoeuvres Preserve life • Good planning • Thorough preparation • Avoidance of unnecessary risk • Appropriate and timely resuscitation (ABC)

44. Life-Saving Manoeuvres Preserve life Prevent further injury • Good planning • Thorough preparation • Avoidance of unnecessary risk • Appropriate and timely resuscitation (ABC) • SEEK MEDICAL ADVICE EARLY • Identify risks to casualty and treat appropriately • Protect casualty: • Cervical spine • Shock • Hypothermia

45. Life-Saving Manoeuvres Preserve life Prevent further injury Promote recovery • Good planning • Thorough preparation • Avoidance of unnecessary risk • Appropriate and timely resuscitation (ABC) • SEEK MEDICAL ADVICE EARLY • Identify risks to casualty and treat appropriately • Protect casualty: • Cervical spine • Shock • Hypothermia • Administer fluids • Immobilise fractures • Give pain killers • Keep warm • Reassure • Monitor vital signs • Constantly review

46. Life-Saving Manoeuvres Preserve life Prevent further injury Promote recovery Provide a diagnosis and deliver a stable casualty to shore • Good planning • Thorough preparation • Avoidance of unnecessary risk • Appropriate and timely resuscitation (ABC) • SEEK MEDICAL ADVICE EARLY • Identify risks to casualty and treat appropriately • Protect casualty: • Cervical spine • Shock • Hypothermia • Administer fluids • Immobilise fractures • Give pain killers • Keep warm • Reassure • Monitor vital signs • Constantly review • SEEK MEDICAL ADVICE EARLY • Full history and examination • Keep full records for evacuation of casualty • Knowledge of rescue procedures

47. Life-Saving Manoeuvres Locate and assess casualty

48. Life-Saving Manoeuvres Locate and assess casualty Stabilise boat with reliable helmsman and reduce sail

49. Life-Saving Manoeuvres Locate and assess casualty Stabilise boat with reliable helmsman and reduce sail • Immediate treatment • Airway, Breathing, Circulation • Pain relief • Immobilisation of fractures

50. Life-Saving Manoeuvres Locate and assess casualty Stabilise boat with reliable helmsman and reduce sail • Immediate treatment • Airway, Breathing, Circulation • Pain relief • Immobilisation of fractures • Retrieval of casualty • To safe place (galley table, bunk, saloon floor) • Care with passage down hatch • Re-assess and remove clothing • Undertake further treatment • Keep warm