Challenge: Medical Treatment at Sea

[crazyhorse]

Obviously the patient has a subdural hematoma and you need to stop the bleeding QUICK! A tourniquet around the neck will stem the flow and get out the black and decker!! A 1/2 inch bit should do it and start drilling exploratory holes in the cranium until you find a clot. Hook up the air intake of your auxiliary motor to a sturdy pipe, run the motor and apply the pipe to the wound. This should draw out the offending clot!! Patch up and give two aspirin.... If you think I am serious then please give up any idea of long distance sailing! (Accidents happen, AVOIDANCE is the ONLY cure)

[Wotname]

I was with you all the way until you suggested the two aspirin, then I knew you were only kidding as the symptoms (and your treatment) really required three.

[Sjadows]

Okay, I know this is probably a bit late, but I have a couple of actions I'd like to throw out there just to see what responses I get. There's several things that I would (off the cuff and with "no medical training") have done as well.

The first one is a word association test, or other form of testing for a clear ability to think. I've been sailing with Ms. Chris for awhile, I've (knowing me) probably attempted to have some intellectual conversations - I should have a decent baseline of how she responds in certain conversational situations. It should be possible to turn a conversation back into one of those areas and compare her responses now with regard to the responses earlier. Including keeping an eye out for inappropriate responses. I also would have probed further into why she thought she was pregnant - This could be completely valid, however it could equally be a mild form of dementia, which would indicate some form of at least semi-permanent damage has occurred - At which point, despite what she says, my overriding concern would be to get her to medical attention as soon as possible.

Secondly, I would have recommend a more detailed check of the skull. Besides swelling, are there any other sore spots, is the swelling hard (like an egg) or soft? I would assume those are important indicators.

Also I would want to know what the last thing she remembers is - If she's lost more than five minutes of time, then we're looking at something is going on besides simply a single failure to convert short term to long term memory.

Also, I would have insisted on bed rest. If she absolutely would not and continued to insist she was fine, I would have her sign a document stating what happened and that she wished to return to duty in spite of my objections, as well as an account (signed by both parties) of what occurred.

The documentation simply because of the fact that in the past some-odd years I've developed a habit of document, document, document. Also because of the fact that I want to avoid any possible lawsuits, including the one where she survives and decides to bring legal action against me for allowing a preventable accident to occur, or not insisting on medical attention ASAP. Head injuries are nasty, inherently.

(Also, I've added these preventers to things to research, since I'm new to all this sailing stuff.)

You've also got me considering that a good DSM-IV and some general medical reference texts would be a good idea to have onboard. I don't have to know it all, I just have to be able to reference it. With digital storage these days, in fact, it should be possible to carry around a decent medical library, actually, that is searchable. (This would easily get to be very expensive. Textbooks and/or references are NOT cheap.)


Also, since I have a retired doc for a father, I asked him what he would do - His response was, still being a licensced physician, he would have an Opthalmoscope in his kit, which he would use to look for signs of ICP where the optical nerve enters the eyeball - brilliant. This is the only response from him, all the other paragraphs are mine.

Other than that, it seems to me almost like a sudden fatal aneurysm. My diagnosis of course is not based on advice from a professional (except for the disclaimed paragraph above) and could very, very easily be wrong. Also, aneurysms generally don't show symptoms, afaik, that are observable without lots of expensive equipment before you run into the "Poof, stuff in your head goes boom!" problem.

It should be noted, I think, that to the best of my memory, aneurysms can develop from blood clots in that area, which could have been caused by the blow to the head. In this case, actually, asprin (or warfarin in a controlled dose, aka rat poison) would have been indicated. However, after ruling out ICP, you have no way of knowing if there IS a blood clot you need to worry about, and if there's something else wrong (or she IS pregnant and not suffering mild dementia) then giving her warfarin would be a very, very bad idea....

If you're looking at a major head trauma, I think the safe course it to set out a nice reclining folding chair on the deck and give her a book. Tell her she's on strict bed rest and relaxation therapy until you can get a doctor involved.

Okay, that's a bit more than my two cents worth.

Ah, see the following information for aneurysm - They do include "sudden death" as one of the things that can happen.

[Talbot]

I still prefer the Black and Decker answer.

[Sjadows]

Oh, personally I think it's valid too.

/If/ you have a way to locate where the drillbit needs to be and a way to excessively sterilize it.

i.e. You've gotten medical advice (From someone who knows a WHOLE lot more than me), have successfully rigged a method to completely prevent the head from moving, have her passing out drunk, (unless you're actually able to anesthetize), have the ability to sterilize the drill bit, and you're down to "She WILL die and this is our only hope.".

In other words, this has to pass the test that "the disease is worse than the cure". Even so, you're in a non-sterile environment, and doing an open cranial procedure in a non-sterile environment is a really good way to kill your crewmate. Bad mojo, man, bad mojo!

Except the symptoms thus far described don't fit with ICP (as discussed) which means it would be a moot point...

Chris died from an aneurysm, is what I would believe until an autopsy was performed and showed otherwise, and the only possible preventative action would have been to keep her BP down and distract her with books. If there was opiate narcotics aboard, I'd suggest those - keep her relaxed and sleeping mostly - but you wouldn't do that unless you knew she was about to have an aneurysm... and had schedule II or III controlled substances on board as a matter of course.

If you drill, you're treating a problem she probably doesn't have, you're practicing medicine without a license, you're in all kinds of legal, uh, trouble, shall we say... You're only possible out is if you've been instructed to do so by somebody who has the authority to do so. I have no idea who this might be.

The way I interpret the challenge as posed and thus far explained, you're in a lose / lose situation unless you chose to enforce bed rest for no discernible reason. In other words, the only "maybe" out is to treat every traumatic head injury as if it will have unexpected complications. (Frankly, this is the wise course of action.) However, this falls into the risk management category.

The only way to protect yourself, if she absolutely refuses to rest that I see is if you're paranoid and insist on excessive documentation. Otherwise, you can get yourself into a wrongful death lawsuit, "He should have insisted, this death was preventable." If you're wrong and she's fine, she'll probably find it amusing in six months. (Also, she'll probably be willing to sail with your retired selves in the future - she knows if something goes wrong, you'll go as far as you feel you need to to see that she's safe.) If you're right, and she insists on working anyway, she doesn't care any longer, but you have evidence that without evidence supporting your position you were unwilling to effectively imprison her against her will. Anyway.

That being said, I don't believe you're serious, so my tongue in cheek response contains the words "black gold" and "drill" ;P

[zeehag]

ok--here goes--you have already given him aspirin and he is on his death bed--have him sign boat over to you to avoid legal issues in foreign countries.
make irish coffee with lotsa booze
share with him so he forgets he signed over his boat
call for help so he doesnt die
run like hell because when he gets better yer in biiiig trubbles...