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Old 17-02-2015, 15:41   #106
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Re: Medical Equipment AED Onboard

NO NO NO GoingWalkabout.......NOT TRUE.
Absolutely no TPA!
Theoretically you could murder someone who had a chance on their own!!!
Look I am getting more involved here than I want to be but your information is dead wrong. You can have limited bleeds in your head and recover without ANY deficit.
The last patient I had like that was less than 3 days ago and he was 82!!
Please no TPA.
I believe your intentions are golden but TPA is dangerous in the best of hands, Anyway have you ever seen the price of TPA, could buy 2-3 AED's for what it costs the hospitals.
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Old 17-02-2015, 15:57   #107
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Re: Medical Equipment AED Onboard

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Originally Posted by caradow View Post
NO NO NO GoingWalkabout.......NOT TRUE.
Absolutely no TPA!
Theoretically you could murder someone who had a chance on their own!!!
Look I am getting more involved here than I want to be but your information is dead wrong. You can have limited bleeds in your head and recover without ANY deficit.
The last patient I had like that was less than 3 days ago and he was 82!!
Please no TPA.
I believe your intentions are golden but TPA is dangerous in the best of hands, Anyway have you ever seen the price of TPA, could buy 2-3 AED's for what it costs the hospitals.
OK. No TPA. . But can I use my drill on his head? Cats are very stable platforms.
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Old 17-02-2015, 15:59   #108
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Re: Medical Equipment AED Onboard

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Originally Posted by GoingWalkabout View Post
OK. No TPA. . But can I use my drill on his head? Cats are very stable platforms.
Of course you can.
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Old 17-02-2015, 16:12   #109
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Re: Medical Equipment AED Onboard

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All great suggestions. Thank you. The only thing I would question is about TPA and I still have an open mind about it. This is what I'm thinking. If a victim of stroke is in say the middle of the Atlantic then one of two things are primarily going on. Either a blood clot or a brain bleed. Flip a coin and you have just the same odds of being right or wrong. In the case of a brain bleed out in the middle of the Atlantic your toast. In this case I would recommend a living trust that directs your burial at sea. If a blood clot then as each half hour goes by you have the high probability of suffering irreversible brain damage and possible death or at the least severe functional deficits. We also know that if given in the first half hour to 1 hour TPA a brain clot victim can not only be saved but walk away from the situation unimpaired in a lot of cases.

So if you have an intracranial bleed miles from anywhere your prognosis is as good as dead. If you have a clot then you have a very good chance of surviving if you are immediately administered TPA. So I can see the clear logic of administering TPA because if you've got a serious bleed from a ruptured vessel your going to die anyway. Unless you have a good Neuro sailing with you and he/she brought along his cranial saw. Mind you, you could use your boat drill to relieve the pressure but its a little difficult to use a drill on a persons head in high mid Atlantic waves. Unless of course your on a cat.

This probably leads to another important thread. The pros and cons of blue water brain surgery. . Or what medical instruments should you bring on your boat? And is a cat a safer sail boat for brain surgery? Just asking.
A trimaran would be the best platform for a trepanning of course .

As far as carefully using the potentially very dangerous tPA, with your given isolated scenario, why not?
Without any intervention you're 100% dead in a short time with either (given that you have either a clot or bleed of critical impact).
Without the clinical means to determine which it is, indiscriminate thrombolysis using tPA gives you a <=50% chance, still far better than 0%.

Getting the tPA itself without an MD degree (and storing it) is another problem.

Tissue plasminogen activator - Wikipedia, the free encyclopedia
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Old 17-02-2015, 16:14   #110
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Re: Medical Equipment AED Onboard

yes, use the drill, as long as you drill on the side with the dilated pupil.
also doing it on a cat will be safer as long as you are not taking seas on the beam.
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Old 17-02-2015, 16:20   #111
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Re: Medical Equipment AED Onboard

also having a stroke doesn't necessarily mean death. There are many people who present with severe paralysis that get better even without TPA.
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Old 17-02-2015, 16:29   #112
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Re: Medical Equipment AED Onboard

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A trimaran would be the best platform for a trepanning of course .

As far as carefully using the potentially very dangerous tPA, with your given isolated scenario, why not?
Without any intervention you're 100% dead in a short time with either (given that you have either a clot or bleed of critical impact).
Without the clinical means to determine which it is, indiscriminate thrombolysis using tPA gives you a <=50% chance, still far better than 0%.

Getting the tPA itself without an MD degree (and storing it) is another problem.

Tissue plasminogen activator - Wikipedia, the free encyclopedia
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Old 17-02-2015, 16:32   #113
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Re: Medical Equipment AED Onboard

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Originally Posted by caradow View Post
also having a stroke doesn't necessarily mean death. There are many people who present with severe paralysis that get better even without TPA.
And heaven knows that brain damaged citizens can have a long productive life. Look at our Politicians. Well I take back the productive part.
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Old 17-02-2015, 16:32   #114
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Re: Medical Equipment AED Onboard

As a physician, there is always concern regarding well meaning, but untrained personnel using equipment and administering drugs. Are AEDS easy to use? sure...... but without knowledge and administration of CPR, the patient may indeed die from lack of application of correct procedure.

I was on a commercial flight once where a call went out for a dr to give aid to a elderly passenger. When I went forward, an attendant had a med bag open and was getting stuff ready. It was a suspected heart issue by the attendant, or so it looked.

I examined the patient and found no indications of heart issues. I asked a number of questions and then requested the steward to get me a can of 7 up. I gave it to the patient and he began burping and farting. Trapped Gas is a painful thing. That was all it was. A misdiagnosis was easy to make without proper knowledge.

The bottom line is that an AED is a wonderful tool. I would suggest that if a boat owner bought one, that they go along and do proper training and this would cover CPR and minor diagnosis techniques. Just because a machine can 'tell' you something, it doesnt tell you how to fix the problem or indeed how to keep the patient alive.

The Kenomacs are trained nurses. They know how to apply procedures and how to relay reliable symptoms via phone and keep a patient, to the best of their ability comfortable, and more importantly, alive.

I was present at demonstration a few years ago where several people were asked to deploy a liferaft in an emergency simulation. only 3 out of 10 did it correctly and efficiently and in time. I leave the parallel conclusion to the reader.

For those of us who are on the scene, we would use AED, CPR or what techniques we could to get things moving and stable. After that its down to how quick a transfer to a med centre could be facilitated.

Choices come with responsibilities. If you have one best to go all the way and learn how to use it.
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Old 17-02-2015, 16:57   #115
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Re: Medical Equipment AED Onboard

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Originally Posted by weavis View Post
As a physician, there is always concern regarding well meaning, but untrained personnel using equipment and administering drugs. Are AEDS easy to use? sure...... but without knowledge and administration of CPR, the patient may indeed die from lack of application of correct procedure.

I was on a commercial flight once where a call went out for a dr to give aid to a elderly passenger. When I went forward, an attendant had a med bag open and was getting stuff ready. It was a suspected heart issue by the attendant, or so it looked.

I examined the patient and found no indications of heart issues. I asked a number of questions and then requested the steward to get me a can of 7 up. I gave it to the patient and he began burping and farting. Trapped Gas is a painful thing. That was all it was. A misdiagnosis was easy to make without proper knowledge.

The bottom line is that an AED is a wonderful tool. I would suggest that if a boat owner bought one, that they go along and do proper training and this would cover CPR and minor diagnosis techniques. Just because a machine can 'tell' you something, it doesnt tell you how to fix the problem or indeed how to keep the patient alive.

The Kenomacs are trained nurses. They know how to apply procedures and how to relay reliable symptoms via phone and keep a patient, to the best of their ability comfortable, and more importantly, alive.

I was present at demonstration a few years ago where several people were asked to deploy a liferaft in an emergency simulation. only 3 out of 10 did it correctly and efficiently and in time. I leave the parallel conclusion to the reader.

For those of us who are on the scene, we would use AED, CPR or what techniques we could to get things moving and stable. After that its down to how quick a transfer to a med centre could be facilitated.

Choices come with responsibilities. If you have one best to go all the way and learn how to use it.
I've been in horrific situations such as Haiti day 2 after the earthquake. Just in the first seven days I attended to more people in emergency than a regular Doctor would have handled in a lifetime. I remember talking to one Dr who I brought relief docs and nurses too who handled more severe trauma patients in the first dew days than he had all the time he was a Doc in Vietnam.

Bottom line is I've seen more dead bodies than any person should ever see and I've seen heroic Doctors do all to save lives. I will always do whatever it takes to save a life.

Regarding the use of an AED I agree in getting CPR and AED training but hang it if any of you without training see one around when a person falls to the floor grab it and use it. Training or no training. These modern day devices talk to you and will only give an automatic shock if one is medically indicated. Be brave and do the right thing.

I give a big yes for an AED on board. As well as a stash of Aspirin and having been involved in field amputations when there was no morphine I would be bringing a vial of that along as well. I also think a well stored oxygen tank would be a great idea as well as an IV with appropriate stand by bags. Be careful with the use f oxygen though since it can be contra indicated in the case of some serious asthma events. Great backup though after a heart event. Again yes to the AED.
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Old 17-02-2015, 17:03   #116
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Re: Medical Equipment AED Onboard

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Originally Posted by Leo Ticheli View Post
Are you suggesting that the purchase of an AED prevents one from also having other safety and emergency equipment?
Well in a way yes. There is always a limit to what you will spend on gear, including safety gear and I'm suggesting that an AED would be fairly far down that list.
There are a few things I need to add to my boat, oxygen, for example, but the purchase of the AED will not prevent me from obtaining them; I would hope that's true of most others who choose to add an AED, but that's just my feeling.
It certainly doesn't prevent you from getting the other items. I was just trying to make the point that some of those other items would, in general, increase the safety of your crew more than an AED.

I don't think I'll ever need my life raft, or my fire extinguishers, or the laser signaling device, or the QuikClot, or the pain meds, or the hand-operated water-maker, or all the other stuff that's usefully only in a nightmare situation, but I feel better having it all on board.

If one's budget is so constricted that hard choices need to be made on safety gear, or one fears a less than eupeptic outcome from use of the AED, I certainly see your point. It's an individual choice, not like the requirement to have life jackets.
Certainly an individual's choice. And in the comments I made they were oriented to the value of an AED in a remote cruising situation. If you are cruising near advanced care, it may have some decent value. In an offshore boat in remote locations, I question if it has much or any practical value.

I'm not inclined to try to talk anyone into having or not having an AED; in my case, with myself, my wife, and close friends having irregular heart rhythms, it seems like a prudent choice.
I'm not trying talk anyone into or out of an AED. I'm out cruising and make choices just like anyone else makes theirs.

Thank you for your concern.

Fair winds,
Leo
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Old 17-02-2015, 17:19   #117
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Re: Medical Equipment AED Onboard

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Of course you can.
It's going to be hard to make that look like an accident, later on in court.
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Old 17-02-2015, 17:20   #118
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Re: Medical Equipment AED Onboard

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yes, use the drill, as long as you drill on the side with the dilated pupil.
also doing it on a cat will be safer as long as you are not taking seas on the beam.
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Old 17-02-2015, 17:24   #119
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Re: Medical Equipment AED Onboard

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It's going to be hard to make that look like an accident, later on in court.
If things go wrong, Man Overboard. . Just kidding. In case a prosecutor reads this ten years ahead. Really no intentions of doing this at all. I would never ever do this. Never.
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Old 17-02-2015, 17:27   #120
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Re: Medical Equipment AED Onboard

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Originally Posted by weavis View Post
As a physician, there is always concern regarding well meaning, but untrained personnel using equipment and administering drugs. Are AEDS easy to use? sure...... but without knowledge and administration of CPR, the patient may indeed die from lack of application of correct procedure.

I was on a commercial flight once where a call went out for a dr to give aid to a elderly passenger. When I went forward, an attendant had a med bag open and was getting stuff ready. It was a suspected heart issue by the attendant, or so it looked.

I examined the patient and found no indications of heart issues. I asked a number of questions and then requested the steward to get me a can of 7 up. I gave it to the patient and he began burping and farting. Trapped Gas is a painful thing. That was all it was. A misdiagnosis was easy to make without proper knowledge.

The bottom line is that an AED is a wonderful tool. I would suggest that if a boat owner bought one, that they go along and do proper training and this would cover CPR and minor diagnosis techniques. Just because a machine can 'tell' you something, it doesnt tell you how to fix the problem or indeed how to keep the patient alive.

The Kenomacs are trained nurses. They know how to apply procedures and how to relay reliable symptoms via phone and keep a patient, to the best of their ability comfortable, and more importantly, alive.

I was present at demonstration a few years ago where several people were asked to deploy a liferaft in an emergency simulation. only 3 out of 10 did it correctly and efficiently and in time. I leave the parallel conclusion to the reader.

For those of us who are on the scene, we would use AED, CPR or what techniques we could to get things moving and stable. After that its down to how quick a transfer to a med centre could be facilitated.

Choices come with responsibilities. If you have one best to go all the way and learn how to use it.

When I was in the Navy, we did a lot of drills, covering pretty much every imaginable casualty and combinations of casualties. At the time, I didn't enjoy them, but I always knew it was necessary and might one day save all of our lives.

I still think drills are a very good idea, and I plan on becoming very well acquainted with all of my safety gear. In an emergency isn't the time to be reading labels and looking for instructions. I can't speak for anyone else, but it seems like common sense to me.
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