Challenge: Thinking Outside the Medical Box | Seizure, Perhaps Diabetic

[zeehag]

1 you will not be able to STOP a seizure unless you carry injectible valium on board.
2 you already know the a-b-c s of cpr.
3 lie individual on left side in swimmers position
4make sure a tongue blade is handy
airway
breathing
then if nothing, cardiac compressions.
this doesnt work if the person is still seizing.
if blood sugar is low, place sugar between lips and teeth. may need a lot of that--about 2 teaspoons.
when individual is ok, drink some rum. ye might wanna add some juice or cola to that rum. after all, ye didnt go sailing to be a medical rescue sort, didja.

do NOT give insulin until you KNOW the blood sugar is waaay high. seizing usually happens with LOW bs, not high.

ok so now ye all know why i typo bad...LOL......was intensive care and emergency at bedside and manager of post anes care ----- and other intensive care area kinda nursee for 30+ years.

[WarmBreeze]

And to think...This whole fiasco could have probably been avoided had she been upfront about her medical state/history.

Bravo to all who endured this ordeal and hope she knows how blessed she is to have had such a crew.

[avb3]

Originally Posted by GordMay

Some FREE online medical books: ......

GordMay, where do you GET all the information you post?

On so many topics you have concise, understandable and readable links and information.

Thanks from all of us in keeping us provide with it!

[OErjan]

capngeo, justy one word, thankyou!
also thanks to Gord May for the excellent links.

[Therapy]

Originally Posted by capngeo

Wow! Jumping to all sorts of conclusions... so I ‘ll add a little more.....
She was down below, no worries about falling overboard... downtime was unknown, but she is on her third WITNESSED seizure right now... she was breathing when the seizures abated, but shallow and slow. No AED, NO BVM, bandaids and aspirin are all you have in the med kit.

I told my buddy to go below and rifle through her bags and belongings; try to find anything medical related and tell me what it was.... remember this was all third hand through email/SSB link... he found lebetiracetam (Keppra), Humulin N, Heparin, and Biaxin... a glucometer, an automatic BP cuff, Xanax, Valium and an epi pen hmmm...

Oh CRAP! another seizure, BRB!

BTW, Thanks for the flowers Doc.... but remember when we’re baffled, we call YOU guys!

I only got this far and now you toss this out. If it was number 3 then the skipper has already the info he needs from her.

A
B
C
G

[AK_sailor]

Originally Posted by andrewsc

You are probably the most qualified person to answer the question in your scenario capngeo. I have been an emergency medicine physician for 15 years. Outside of the hospital I find that prehospital trained personnel are generally more effective than your average physician. Imagine yourself in the wilderness, on a plane, on a boat... would you rather have an orthopedist taking care of this lady or a paramedic......

In Alaskan wild med training classes there is an old saying:
"In some situations, a team of huskies will be more valuable than a team of surgeons."
The idea being that the huskies might help speed you to someplace where the surgeons could do some good!

Interesting thread. Looking forward to the next one.

[Therapy]

Originally Posted by capngeo

Thanks guys, but believe it or not, I've gotten PMs condemiming me for not allowing her to die! One suggested that I am going to encourage cruisers to play doctor. In light of that, I want to say one more time: THE ACTIONS DESCRIBED ARE NOT A SUBSTITUTE FOR SEEKING PROFESSIONAL MEDICAL CARE. THE SCENARIO IS ONLY A LAST DITCH EMERGENCY EFFORT TO SAVE A LIFE, AND IS CONTRARY TO STANDARD MEDICAL PROTOCOLS FOR A SIMILAR SHORE SIDE EMERGENCY!

OK that out of the way, it seems the majority has an interest in seeing more. I'll try to regularly drag one of these out of the closet. The above was a real event almost in real time. I'll see if I can adapt some land side scenarios to the water. I'll do it as a continuation of this thread. If any other medical people want to share a story, I'd be honored.

No prob capt.

But it appears to me that even with a first aid course or even a EMT course the only way to really help her would be the way it was. Get in contact with a professional. Nothing else would really help much even if someone who can read read the PDR. IMO.

[tartansail]

Great case, Capngeo! And a good idea to throw them out periodically. It's just as important for the skippers to have a plan when something arises with a crewmember as with any other critical asset on board.

I used to be a physician, but haven't practiced for a while. I have been the designated medical person on offshore trips. No question that I would have wanted a paramedic around to make me feel more secure. That said, a couple of things that CapnGeo mentioned but bear repeating:

1. Everyone on board needs to give an honest medical history. Finding stuff out in the middle of an emergency is not the way to go.
2. If you have a means to communicate with shore-based resources, do so. There are people willing to help just the way Capngeo did. There are also services that you can use. It's good to know who you're going to contact before leaving the dock. If you will have that access, contact the service in advance to see what you should have on board by way of supplies and medications. They can give you advice, but if they recommend a medication, you need to have it on hand.
3. The rectum is a great vehicle for getting medications into the system. I tell my crew that, if they can't keep down oral fluids, I'm going to give them a suppository. Amazing how effective it is at focusing them on prophylaxis. I also stock an enema set up. It's a good way to rehydrate someone who's unable to keep fluids down and to get glucose into a diabetic.

[avb3]

Originally Posted by tartansail

[*]The rectum is a great vehicle for getting medications into the system. I tell my crew that, if they can't keep down oral fluids, I'm going to give them a suppository. Amazing how effective it is at focusing them on prophylaxis. I also stock an enema set up. It's a good way to rehydrate someone who's unable to keep fluids down and to get glucose into a diabetic.[/LIST]

Being a somewhat educated lay person (that's a dangerous combination!), I am trying to envision how an enema would be use for re-hydration? The glucose I understand, because of the absorption factor, but even though water would be absorbed, does it not by necessity have to be introduced slowly?

My thought is glucose reacts fairly quickly to bring blood sugars up, where as re-hydration requires larger quantities.

[virginia boy]

If one doesn't normally carry an enema bag, what would be the best way to introduce liquids?

[Astrid]

It does not cost much to get one and they are compact and store easily.

http://www.enemakit.com/

[tartansail]

Originally Posted by avb3

Being a somewhat educated lay person (that's a dangerous combination!), I am trying to envision how an enema would be use for re-hydration? The glucose I understand, because of the absorption factor, but even though water would be absorbed, does it not by necessity have to be introduced slowly?

My thought is glucose reacts fairly quickly to bring blood sugars up, where as re-hydration requires larger quantities.

You're right that you can't just dump in a liter of fluid and expect it to all get absorbed before coming back. Unfortunately, the tube needs to stay in for a while. The kits used for colonic cleansing work fine, but the fluid needs to be introduced more slowly over time. The rectum and lower intestine can absorb fluids pretty efficiently -- 200+ cc/hr for most people.

To be clear, this is only something to consider when someone is severely dehydrated and unable to keep anything down orally. Another advantage to rectal administration is that you don't need to use sterile fluids. You can make up a saline solution or a sugar solution in the galley and administer it rather than stocking sterile IV solutions. OTOH, if you've got a crew member who can start and manage IV's, that's not a bad thing to include in your medical kit.

[ssanzone]

rummage thru her pockets for cash?

::ducks::

[sabray]

I agree that I would have been a a loss. I should do another course. I think the thread is excellent in thinking through how quick things go bad and how you react. I forgot seizure rules for laying n side. I never would have rectal applied any sugar or meds as the conditions were described. Look forward to the next. One thing that I think about are infections particularly mersa and infections similar and requiring large doses of antibiotic.recently a fellow worker my outlaw wife had infections that were unexplained but required 6 -9 days of hospital treatment. Years ago I had a bacterial infection on the back of my ear. Nit hospitalized but dangerous. what are the on board antibiotics that should be carried. Are there out of the box treatments.

[MermaidMuse]

.....and in the event you are not familiar with the pharma meds and/or your medical kit doesn't contain the items described above, hopefully you have a semi fresh onion somewhere on board from which you can squeeze out some juice. One or two drops of onion juice in each nostril is a rural remedy for seizures that can & has worked surprisingly well.