Download CARDIOPULMONARY RESUSCITATION

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
 Cardiac emergencies
 Neurological emergencies
 Respiratory emergencies
 Gastrointestinal emergencies
 Dizziness-Nausea-Vertigo-Seizures
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MEDICAL EMERGENCIES
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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)
 Environment (special)
 Emergency facilities
 Triage
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MEDICAL INTERVENTIONS
A - airway
B - breathing
C - circulation
Cardiac events on board…
 Ischemic heart disease…on earth
 Increasing number of travelers
 Elderly passengers
 Longer distances
 Acute environmental conditions
Open Airway
Look for signs of life
…. to confirm cardiac arrest
 Pulse check if
trained to do so
 Take no more than
10 seconds for
assessment
A-airway
MEDICAL INTERVENTIONS
Supraglotic devices
Trachea intubation
Emergency cricothyroidotomy
A-airway
MEDICAL INTERVENTIONS
A-airway
Cricothyroidotomy
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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
Needle thoracentesis
Chest tube placement
B- breathing
Mechanical ventilation
Ventilator (mechanical) – bag valve vent
Secure airway (LMA-intubation)
Sedation
Mechanical ventilation parameters:
frequency-oxygen inspiration fraction-inspiration
pressure / tidal volume-PEEP
B- breathing
Chest tube placement
Hemothorax-pneumothorax
Needle thoracentesis (hypotensiondecreased or absent breath sounds to one
side)
Emergency kit (Heimlich valve)
C- circulation
MEDICAL INTERVENTIONS
CPR
Defibrillation / Cardioversion
 Temporary cardiac pacing
 Central vein cannulation
 Vein cutdown
Chest compression
 30:2
 Compressions
“Centre of chest”
4-5 cm depth
100 min-1
 Uninterrupted
compressions when
airway secured
 Avoid
Provider fatigue
Interruptions
Self-adhesive electrodes
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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 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-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 output
CPR… to buy time!!!
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BLS keep
brain
alive....
Until an
AED used
…more
MEDICAL INTERVENTIONS
 Urinary catheter
 Nasogastric tube
 Anti Epileptic
 Bronchodilations
Analgesia- Sedation
SUMMARY
Ischemic heart disease is a leading
cause of death
Importance of clinical signs early
recognition and prevention of a cardiac
arrest event
Following the ALS algorithm
Early air-evacuation
Post Resuscitation Care
 Similar with the intervention on land