INDEX

Chapter Subject Area PageNo.

1. GENERAL PRINCIPLES .............................................................. 2

2 BODY STRUCTURE AND FUNCTION ........................................ 3

3 CASUALTY ................................................................................... 20

4 TOXICOLOGICAL HAZARD ABOARD SHIPS ............................ 35

5 EXAMINATION OF PATIENT ....................................................... 46

6 SPINAL INJURIES FRACTURE, DISLOCATIONS AND

MUSCULAR INJURIES ............................................................... 48

7 BURNS, SCALDS AND ACCIDENTS CAUSED BY ELECTRICITY

AND EFFECTS OF HEAT AND COLD ....................................... 75

8 MEDICAL CARE OF RESCUED PERSONS INCLUDING DISTRESS,

HYPOTHERMIA, COLD EXPOSURE ......................................... 80

9 RADIO MEDICAL ADVICE PHARMACOLOGY ........................... 91

10 STERILIZATION ........................................................................... 93

11 CARDIAC ARREST, DROWNING AND ASPHYXIA .................... 97

 PREFACE

Dear Student,

Welcome to HMI. It is with great pleasure that we present this book on

Medical First Aid to you. Keeping them long tradition of First Aid
organization from the. Red Cross; St. Johns Ambulance and other First
kid Organizations, we have, endeavored to keep the subject content as
envisaged by them, intact. We also have, kept in mind new guideline
provided by the administrative, authorities to ensure that we do not dilute,
the contents of the course.

It has been set in a convenient sequence to provide, information on

preserving lives at sea. Statistics, collected from the ships and other
sources; show that the history of deaths due, to accidents at sea has
been largely attributed to insufficient knowledge of first actions to be
taken during such situations. The vital ABC as it is called has been
illustrated / written in this book in great detail, providing step by step
information about the subject. There is also a full chapter devoted to the
responsibilities of a first aider in preserving life.

This book also provides information collected from various sources, case
studies and experience and faculty on, approach, handling, and actions to
be taken when an incident occurs involving a casualty in an emergency.
A flow chart on the subject of CPR, illustrations on fractures and
bandages would be very handy to the readers of this book as it provides
step by step procedures to be carried out by a seafarer to restore life and
minimize the effect of trauma. This book also provides details about
various types of wounds, injuries, bleeding and simple sprains & fractures
as they may occur in day today work at sea. Illustrations provided to give
a realistic look to body parts is an added advantage in this book.

The illustrative diagrams, photographs, flowcharts are included in an easy

to understand manner to the prospective seafarer. There is something for
everyone who reads this book. Meanwhile all efforts have been made to
keep the subject simple. There are some places where the medical terms
are retained as it is unavoidable. Those areas where you find it difficult to
understand, you may seek the help of faculty or trainer to clarify the
issue. Attending the theory classes supported by practical training
provided during the course is essential, as one doesn't necessarily
supplement the other.
The reader is hereby warned that the contents / illustrations are not to be
taken as a treatment for any ailment or medical disorder. HMI is not
responsible for any misguided act by any individual. This book should be
treated only as a basic guide to first aid. Further study of the subject, and
rehearsals of the practical aspects shown in this book needs to be
stressed. As the saying goes every first aid action shall be followed by
professional medical treatment.

We wish you good luck to be a good first aider at sea.

With warm regards,

PRINCIPAL

HOON MARITIME INSTITUTE

 Chapter 1

GENERAL PRINCIPLE

FIRST AID trained first aider attending the injured.

First aid is the emergency medical If enough people are present, one

help given to a victim of sudden injury may summon help, and others

or illness(casualty), till the arrival of reassure any un-injured people who

an expert medical personnel i.e. a are in distress.

doctor. 6) Assess injuries in order of priority

A casualty is a person who is in a e.g. controlling bleeding for one
need of emergency medical help casualty may take precedence over
or treatment. those not breathing and/or heart
The approach to first aid situation stopped & unconscious.
on finding a casualty :
7) Be a part of the team-Accept
2) Take a few seconds to assess the
instructions and be helpful. '
first aid situation and the immediate
surroundings. Remember the aims of first aid:
3) Do not become another casualty.
i) To preserve life
Beware of live electrical equipment &
fumes such as smoke or coal gas. ii) To lessen suffering and

4) Separate the casualty from danger. iii) To prevent deterioration of the

5) Maximize resources that are injured person. This includes

available. Use those people best arranging for appropriate transfer

equipped for each task e.g. the of the casualty.

 GENERAL PRINCIPLES OF FIRST
AID:

i) Make a rapid examination of the patient to assess the extent of the injury;

ii) Check breathing, pulse, look for serious injuries or bleeding and assess the level of
consciousness.

iii) Arrest serious bleeding to prevent shock.

iv) Clear the blocked airway.

v) If breathing has stopped, give artificial respiration.

vi) Commence heart compressions, if the pulse cannot be felt.

vii) Give the 'recovery position' to the unconscious casualty.

viii) Place the casualty in the most comfortable position possible and loose tight
clothing e.g. the neck tie so that he can breathe easily.

ix) When in doubts of a fracture make use of bandages & splints.

x) Do not give alcohol(orally) inany form.

xi) Never consider anyone to be dead until you and others agree that.

a) No pulse is felt.

b) Breathing has stopped

c) The eyes are glazed & sunken

d) There is progressive cooling of the body

 CHAPTER 2

BOSY STRUCTURE AND FUNCTIONS THE ANATOMY

 THE HUMAN BRAIN

The brain is situated within the cranium or skull. As well as controlling body
functions and interpreting incoming signals, the brain is the site of memory,
learning, thinking and reasoning.

Within its mass of approx. 1.25 kgs are thousands of millions of neurons and
their associated myraides of connections.

The brain comprises a number of regions or structures.

1) CEREBRUM

It comprises about 3/4th of all the brain tissue. It is composed of two

hemispheres which are thrown into many folds giving itself a wrinkled
appearance. The enfolding are called as sulci and the surface as gyri.

2) THE BRAIN STEM

It is about 10 cms long. It is comprised, in ascending order.

a) MEDULLA OBLONG ATA

b) PONS

c) MIDBRAIN

3) CEREBELLUM

It overlies the upper part of the brainstem. It is responsible for the

maintenance of balance, muscular co-ordination and posture.
 The meanings are the 3 membranes which cover the brain. The
meninges (inner most covering)secretes the cerebro-spinal fluid.

A CUT-SECTION (VERTICAL) PASSING THROUGH THE FACE

The passageway which conveys air from the nose to the larynx, the
pharynx is commonly known as the throat, although in fact it forms only
part of it.

Continuous with the food pipe or esophagus, measuring from 12.5 to 14

centimeters in length and wider above than below.

The pharyngeal cavity or opening is divided into the upper or nasal area
and the lower or opharyngeal areas. The tonsils are located in the oral
pharynx.

The movements of the pharynx include closing to separate the nasal

and oral areas; closing, in different way to separate the mouth from the
pharynx; and swallowing.
 THE RESPIRATORY SYSTEM

When a person breathes in air, it passes through the nose or mouth and then
past the larynx into the traces which is about 12.5 cm. At its lower end, it divides
into two main tubes called bronchi.

The main air passage in each lung(the bronchus) divides into successively
smaller branches called bronchi & bronchioles which carry the inhaled air to all
parts of the lugs. Each small branch terminates by forming a cluster of very tiny
air sacs(the alveoli).

A fine network of blood vessels covers the surface of air sac thereby permitting
gas exchange by diffusion. Oxygen from the inspired air passes through the thin
tissues to combine the hemoglobin. Waste gases, mainly carbon-dioxide pass
into the air sac and are expelled on breathing out. The act of breathing is mainly
due to the diaphragm moving up and down.
The pulmonary circulation carries blood to and from the lungs. In the lung
capillaries, the blood is brought into close relationship with air, it gives off some of
its carbon dioxide and acquires a fresh supply of oxygen. Thus, the pulmonary
arteries carry oxygen-poor blood from the right heart chambers to the lungs.

The systemic circulation distributes to, and collects form, all the other tissues and
organs of the body. In the systemic capillaries, oxygen, nutritive materials and
hormones are given to the tissues, and exchanged for carbon dioxide and other
waste products. Thus, the main systemic artery, the aorta, and its branches carry
oxygen-rich blood from the left heart chambers to the tissues, and the veins return
oxygen-poor blood to the right heart chambers, through the two major veins, the
superior vena cava and inferior vena cava. It should be noted, however, that the
circulation in the foetus is quite different.
 THE GASTRO INTESTINAL SYSTEM

Once the food is chewed & lubricated with saliva in the mouth it is swallowed via the
pharynx into the esophagus, a straight muscular tube which ends in the stomach. A special
band of muscle at the junction of esophagus prevents the food from being regurgitated
back into the esophagus.

The cells that line the stomach produce a highly acidic fluid called gastric juice which
facilitates the process of digestion. The stomach also acts as a reservoir for food. Although
the meals are taken infrequently, because of strong sphincter at the lower end of the
stomach, only small amounts of the partially digested food enters the duodenum, the first
part of the bowel intermittently.
Small intestine - A long narrow tube, the small intestine is almost 7 mtrs long, diameter of 2
to 5 cms.

Large intestine - is a wide-bore tube, roughly 1.5 meters long, which arches upwards and
across the abdominal cavity before descending the left side to join with the rectum. The
rectum is roughly 150 mm long and is continuous at the lower end with the very shortened
canal which opens to the exterior.

The liver is the largest internal organ of the body, is situated in the upper part of the
abdominal cavity, mainly on the right side, but extending to the right side, but extending to
the left, beneath the lung and underlying the lower ribs. The liver weights 1.5kg and is
normally red-brown in color.

Liver is the 'chemical powerhouse' of the body. Most of the products of digestion are
transported to liver form the small intestine via portal vein. These products are metabolized
for further use by other body tissues and many are stored in the liver. Liver cells form and
excrete bile into the gall-bladder. Bile is concentrated in the gall bladder and subsequently
released into the upper part of the intestines(duodenum) which assists in absorption of fats
& fat soluble vitamins.

The pancreas is a fleshy gland about 1 5 cm long situated deep in the upper part of the
abdomen, the head of the pancreas is situated on the right side in the curve of the
duodenum and the distal part ends close to the spleen. Pancreas secretes hormones,
insulin&glucagon.
 THE URNINARY SYSTEM

The urinary system comprises of the kidneys, ureters, the body. Each kidney contains over a
million enthrones urinary bladder and the urethra. which are necessary for filtration and re-
absorption. It also regulates the bloods acidity level.

The kidneys are bean shaped approximately 11 to 12cms long. 6cms wide and lie at the back
of the abdomen. It is one of the main excretory organs of

URETER

The tube conveying urine form each kidney to the bladder funnel shaped dilatation called the
pelvis of the urethra, is called the ureter. It is 25-30cms long, narrow thick walled muscular
tubes, commencing at the kidneys as a funnel shaped dilation called pelvis of the urethra.
Each urthra opens into the Urinary bladder
 URETHRA

The main urethra is a fibro-elastic tube about 20 cms opening to the exterior it is used to
convey urine from the long which runs from the bladder through the middle of bladder to
the exterior i.e. the external urinary meats in the prostate and the lower section of the penis.
Before the end of the penis.

ORGANS OF THE MALE URO-GENITAL SYSTEM

The male external genital organs comprise the penis and the scrotum which contains the
testes. The head of the penis, the glans penis is covered by the foreskin or prepuce. The
scrotum is the sac suspended behind the penis. An internal partition separates the right
testis from the left. The skin over the scrotum is supple and wrinkled. The male testes are
egg-shaped glands (3cm in length) within the testes are numerous seminiferrous tubules
which produce the spermatozoa. The cells between these duct produce the male sex
hormone, testosterone.

Above each testicle is the epididymes a convoluted organ in which the ducts of the testis
are gathered and grouped into vas-deferens which with other structures form the spermatic
cord which runs up through the scrotum and passes through the inguinal canal to the
abdomen.

Within the abdomen the two vas deferens pass alone the either side of the bladder to
reach the prostate gland. The seminal vesicles secrete a part of the seminal fluid.
 Chapter 3

CASUALTY

ASSESSING A CASUALTY

LEVEL OF CONSCIOUSNESS

State of consciousness:

This is the level of the individual awareness and the responsiveness of his mind to
himself, the environment and the impressions made by his senses.

State of unconsciousness : Stage I

Drowsiness - Prolonged sleep from which the patient can be aroused.

Stage II

Stupor - This is a state of partial loss of response to the environment. The patient is
difficult to arouse and though he can be aroused, it is slow and inadequate. The
patient is not aware of the environment and falls back into stupor us state.

Stage III

Coma - There is a complete loss of consciousness from which the patient cannot be
aroused by painful stimuli, all reflexes including light reflex (constriction of pupil when
the rays of light are focused on the eye by means of torch) are lost.

2) AIRWAY BREATHING & CIRCULATION

If breathing & circulation are satisfactory and casualty is unconscious then, place
the casualty in recovery or unconscious position to minimize any blockage of
airway by the falling tongue. Anything that may obstruct breathing, such as
vomitus, will come out and not go down the lungs. If there is no breathing and the
pulse can be felt start mouth to mouth respiration".
If both, the breathing & pulse have ceased –

The first aim is to re-establish oxygen supply to the vital organs of the body
especially the brain. Brain damage begins once there has been oxygen deprivation
for four to six minutes.

Therefore both mouth-to-mouth or mouth-to-nose respiration and chest (cardiac)

compression will be needed immediately for proper revival of the casualty.

BABIES AND SMALL CHILDREN

Be more gentle. Tilt babies head back only slightly. Under 2

years, seal your mouth over child's mouth and nose and blow
until chest rises. Continue giving short breaths at the rate of 20
perminute.
3) CARDIO PULMONARY
RESUSCITATION

Comprises of establishing

a) Airway - If patient is unconscious,

open airway; thereafter make sure it
stays open

• Lift up neck

• Push for forehead back

• Clear out mouth with fingers

b) Breathing - If patient is not breathing;

begin artificial respiration; Mouth-to-mouth
or mouth to nose respiration.

• Before beginning artificial respiration,

check carotid pulse in neck. It should be
felt again after the first minute and
checked every five minutes thereafter.

• Give four quick breaths and continue at a

rate of

12 inflations per minute.

• Chest should rise and fall. If it does not,

check to make sure the victim's head is
tilted as far back as possible.

• If necessary, use fingers to clear the

airway.
c)Circulation - If pulse is absent, begin heart compression. If possible, use two
rescuers. Don't delay. One rescuer can do the job.

• Locate pressure point (lower half of sternum)

• Depress sternum 4-5 cm.

• If one rescuer-15 compressions at a rate of 80 per minute and two

quick inflations.

• If two rescuers-5 compressions at a rate of 60 per minute and one

inflation.

Pupils of eyes should be checked during heart compression.

Constriction of a pupil on exposure to light shows that the brain is
getting adequate blood and oxygen.

UNCONSCIOUSNESS

The first stage of unconsciousness is drowsiness, from which the patient

may easily be aroused; the next stage is stupor, from which the pt may be
aroused only with difficulty; The most serious and advanced stage is coma,
from which the pt cannot be aroused at all. Unless the pt is fully alert, or
can be aroused, treat as if unconscious.

STEP 1:

CHECK AIRWAY, BREATHING AND PULSE

 STEP 2:

LOSSEN CLOTHING AROUND THE NECK,

CHEST AND WIAT AND ENSURE THAT
PLEANTY OF FRESH AIR IS AVAILABLE

STEP 3:

LAY PATIENT IN THE

POSITION SHOWN HERE-THE
RECOVERY POSITION-
PREFERBALY WITH THE
LOWER PART OF THE BODY
SLIGHTLY RAISED ABOVE THE
HEAD. THIS WILL ENSURE
THAT VOMIT OR SALIVA DOES
NOT FLOW INTO THE LUNGS.
DO NOT PROVIDE PILLOWS
AND KEEP THE HEAD FLEXED
SLIGHLTY BACKWARDS

STEP 4:

COVER WITH A BLANKET

AND STAY WITH THE
PATIENT UNTIL
MEDICAL HELP ARRIVES.

STEP 5:

IF CONSCIOUSNESS RETURNS, SPEAK

REASSURINGLY TO THE PATIENT, MOISTEN
HIS LEPIS AND PREVENT HIM FROM
HURTING HIMSELF. DO NOT ATTEMPT TO
GIVE A DRINK TO AN UNCONCIOUS PERSON..
RESUSCITATION

EMERGENCY ACTION —

NO BREATHING IMPORTANT

The first and most vital aim of resuscitation is artificial ventilation (artificial
breathing) which ensures that adequate air is getting to the lungs. Regular
breathing must be established, or artificial ventilation continued, to ensure
that oxygen- containing blood reaches all part of the body, especially the
brain.

STEP1:

QUICKLY REMOVE ANY OBSTRUCTION FROM THE AIRWAY; EXAMPLE

PLASTIC BAG, PILLOW,CONSTRUCTION AROUND THE NECK, FROM
MOUTH. CHECK THAT THE AIRWAY IS NOT BLOCKED BY THE TONGUE.

STEP 2:

LAY THE PATIENT FLAT ON A FIRM SURFACE, EXAMPLE FLOOR OR

TABLE. REMOVE ALL PILLOWS.
RESUSCITATION RESUSCITATION
EMERGENCY ACTION —
EMERGENCY ACTION —
NO BREATHING
NO BREATHING Slightly tilt head back, place your open
IMPORTANT mouth firmly over patient mouth and

Check for pulse if pulse is present but nose so that there is no air gap around

casualty is not breathing, continue to the edges of your mouth.

give artificial respiration until natural Gently huff air from your lungs into
breathing recommences casualty until patient's chest rises.
Remove your mouth and watch the
If two First Aiders are present, one
chest fall. Repeat 4 times taking about
compressing the heart and the other
five seconds over each breath. Watch
breathing into the pt, maintain a strict
for spontaneous breathing from
sequence of compressions of the heart
patient. Repeat until breathing
followed by breathing into the pt. DO
recommences.
NOT CHANGE SEQUENCE OR
OVERLAP YOUR ACTIONS.

If heart is not beating, first thump the

lower part of the front of the chest firmly
with the edge of your hand. Re-check
the pulse, if no response to this thump,
begin external heart compression at
once.
Chocking is usually caused by a large lump of food which sticks at the back of the throat
and obstructs breathing. The person then becomes unconscious very quickly and will die
in 4 to 6 minutes unless the obstruction is removed.

Chocking can be mistaken for a heart attack. A person who is choking:

may have been seen to be eating; cannot speak or breathe;

will turn blue and lose consciousness quickly because of lack of oxygen;

can signal his distress (he cannot speak) by grasping his neck between fingers and
thumb. This is known as the 'Heimlich sign' and, if understood by all personnel, should
reduce the risks involved in choking.

If the casualty is conscious stand behind him, place your closed fist against the place in
the upper abdomen where the ribs divide and grasp your fist with the other hand. Press
suddenly and sharply into the casualty's abdomen with a hard quick upward thrust. Repeat
several times if necessary.

You may be able to treat yourself. Try to cough forcibly while using your fist as described.
Alternatively, use the back of a chair, the corner of a table or sink, or any other projection
which can be to produce a quick upward thrust to the upper abdomen.
 If the casualty is unconscious, place him face upward and turn
the face to one side, keeping the chin well up and the neck bent backwards.
Kneel astride him, place one hand over the other with the heel of the lower
hand at the place where the ribs divide. Press suddenly and sharply into the
abdomen with a hard, quick upwards thrust. Repeat several times if
necessary. When the food is dislodged remove it from the mouth and place
the casualty in the unconscious position.
 TRANSPORTATION OF CASUALTY

The method of transport will depend on the situation of the casualty and the nature of injury.

THE THREE HANDED SEAT

One arm and hand of a helper is left free and can be used either to support an injured limb
or as a back support for casualty.

It can be used when a heavy person has to be carried. The casualty must be able to co-
operate and to hold on with both arms around the shoulders of the two men carrying him.
 THE FIREMAN’S LIFT

a) Must never be used unless the helper is as well built as the casualty.

b) It is easy for the helper to carry the casualty along the ladder since one hand is free to
grasp the rail.

c) Roll the patient so that he is lying face downwards, lift him so that, when you droop
down, you can put your head under his left arm.

d) Then put your left arm between his legs and grasp his left hand, letting his body fall
over your left shoulder.

e) Steady yourself and then stand upright simultaneously shifting his weight so that he
lies well balanced across the back of your shoulder.

f) Hold the casualty's arm above the wrist.

 DRAG-CARRY METHOD

It is useful in narrow spaces where it is possible for only one man to reach a
trapped casualty or rescue him.
 NEIL ROBERTSON'S STRETCHER :

Made of shout canvas and bamboo this stretcher is designed for lifting casualties in the
upright position through small hatches, such as manholes or portholes entrances, r for
lowering casualties from heights as in mountain rescue.

The casualty is placed on a stretcher. Rope at the base acts as "stirrups" to hold the
casualty's feet. The strap at the top is passed around the casualty's forehead to hold the
head in position. The upper flaps are strapped around the lower limbs.

The ring at the head of stretcher is used for hoisting. Another length of rope is attached to
the ring at the foot of the stretcher to guide the stretcher.

The stretcher should be stored in a place where it is most likely to be needed together with
a suitable length of rope, preferably made of rat-proof fiber i.e. Nylon.
 CHAPTER 4

TOXICOLOGY HAZARD ON ABOARD SHIPS

POISONING

INHALED POSIONS

Many chemicals produce fumes which can irritate the lungs and cause difficulty in
breathing e.g. chlorine. This will alert you to their presence.

Other gases have no odour. This group includes carbon monoxide, carbon dioxide,
hydrogen and some refrigerant gases. Gases such as carbon dioxide and carbon
monoxide may also be poisonous, particularly in a confined space, because they replace
oxygen in the air and therefore in the blood. The main symptoms of exposure are difficulty
in breathing; nausea, headache, dizziness confusion or even unconsciousness in severe
cases. Remember that precautions against fire and explosion may be necessary for some
gases.
Treatment

Remove the casualty at once into the fresh air. Loosen tight clothing and ensure a clear
airway. Give oxygen if available. Start artificial respiration by the mouth to nose or mouth
method if breathing is absent. The use of a Laerdal Pocket Mask (mouth to mask) is
recommended for resuscitation in the case of poisoning by solvents, hydrogen cyanide
(prussic acid) or petroleum products to avoid poisoning the rescuer. Use oxygen if
available. Start chest compressions if the heart has stopped. In cases of hydrogen cyanide
poisoning where breathing and pulse are present, break an ampoule of amyl nitrite into a
clean handkerchief or cloth and hold under the patient's nose so that he inhales the
vapour.

SEEK RADIO MEDICAL ADVICE as specific treatment may be required. Keep the patient
at rest in bed for at least 24 hours or until he has recovered.

Complications of inhaled poisons

Severe difficulty in breathing with frothy sputum (pulmonary oedema). Pneumonia and
bronchitis.

Swallowed Poisons

Astringents

Many substances will cause chemical burns to the mouth, gullet and stomach if swallowed.
These include bleaches and other cleaners and disinfectants, acids and alkalis and
corrosives as well as petrochemicals. The main symptoms are blistering of the mouth, lips
and tongue and pain in the chest and stomach. The patients breath often smells of the
astringent.

DO NOT MAKE THE CASUALTY VOMIT. If the patient is conscious and in pain then he
may respond to a glass of milk. Do not give painkillers by mouth. Use suppositories or a
painkilling injection if you have any. Other substances can cause acute abdominal pain and
vomiting. These include arsenic, lead, fungi, berries and partly decomposed food. Treat the
patient by making them as comfortable as possible, but do not make them vomit.
Drugs and Alcohol

Drugs may cause harmful effects if taken for recreational purposes or as an overdose. An
overdose may be taken accidentally or as an attempt at deliberate self harm. Common
overdoses include

Sleeping Tablets. These include Diazepam (valium), Temazepam and Nitrazepam. They
cause drowsiness and unconsciousness if taken in excess. This may last for 24 hours. The
breathing may slow down and become shallow. In severe cases it may stop. A similar
picture may be seen with some antidepressants, such as Amitriptyline, or with alcohol.

TOXIC HAZARDS OF CHEMICALS INCLUDING POISONING

Simple painkillers such as paracetamol and aspirin are often taken as overdoses.

Paracetamol may cause abdominal pain and vomiting initially. Larger overdoses can
cause severe liver damage several days later. (Liver damage is rare below 20 tablets)

Aspirin causes vomiting, abdominal pain, ringing in the ears, rapid breathing and semi
consciousness in high doses.

Treatment

Try to discover exactly what was taken (ask the patient, look for empty packets/bottles etc.)
but do not waste time doing so in an emergency.

If the casualty is conscious, give one sachet (50g) of oral activated charcoal in 250 mis of
fluid, if available. Encourage fluids in conscious cases of aspirin overdose.

SEEK RADIO MEDICAL ADVICE.

If the patient is unconscious, then put him in the recovery (unconscious) position and Give
artificial respiration if breathing has stopped. Perform chest compressions if the heart has
stopped.
SEEK URGENT RADIO MEDICAL ADVICE.

Skin Contact

Toxic substances can affect the skin in two ways:

1. Direct contact may cause redness and irritation. In severe cases, burns to the skin
can occur.

2. Absorption through the intact skin producing general symptoms such as nausea,
vomiting, drowsiness, weakness and rarely unconsciousness.

Treatment

The contaminated clothing and shoes should be removed immediately. Wash off the
chemical with copious amounts of water for at least 10 minutes. Continue for a further 10
minutes if there is any evidence of chemicals still on the skin. If a burn has occurred, see
management of burns.

Eye Contact

Many substances, in particular many chemical liquids or fumes of chemicals, will produce
redness and irritation if the eyes are accidentally splashed or exposed to the fumes.
Treatment should be immediate. Wash the substance out of the eye with copious amounts
of cold fresh water as quickly as possible, keeping the eyelids wide open. This must be
done thoroughly for ten minutes. If there is any doubt whether the chemical has been
completely removed, repeat the eye wash for a further 10 minutes. If severe pain is
experienced, physical restraint to the patient may be necessary in order to be certain of
effective treatment. Read about identifying and treating damage to the eye. For pain, give
two paracetamol tablets by mouth every four hours until the pain subsides. If there is very
severe pain use Morphine.
 HANGOVER AND ALCOHOL ABUSE

Basic Guidelines On Consumption Of Alcohol

Any consumption of Alcohol by the persons onboard

No alcoholic beverages are to be served on the during shall not result in blood alcohol
concentration (BAC) of table during meal hours, more than 0.04% by weight at anytime by
individuals.

It is brought to attention of all persons onboard that 2 Officers and watch keeping ratings
will not consume any units of alcohol consumed within the hour will result in alcoholic
beverages 4 hours immediately preceding their BAC of 0.04% be weight and for their
guidance unit of alcohol may be defined as follows

APPROXIMATE ALCOHOL UNIT CONVERSIONS

Volume Unit Volu Unit
me
Beers, Cider and Lagers Table Wine, Other 10cl 1

(>6.0%<12% Acl. By Vol.) 1 10

Liter
bottle
Extra Strength 10oz 2.5
(>4.0%<6% Ale. By Vol.) 30cl. 1 Sherry, Fortified Wines, 6cl. 1
others
(> 12%< 18% Ale.by Vol.) 1 16
Liter
bottle
Ordinary Strength 10oz 1

(>1%<4%Alc. By Vol.) 30cl. 1 Spirits, Liquor, Liqueurs, 1oz 1

Others)
(>16%<40% Ale. By Vol.) 3d. 1

Low Alcohol 10oz. 0.5

(>0.05%<1.0% Ale. By 30cl. 0.5 Any Other Low Alcohol 10oz. 0.5
Vol.) Beverage
(>0.05%< 1.0% Ale. By 300Z. 0.5
Vol.)
WHY DOES A HANGOVER OCCUR?

Alcohol is a diuretic i.e. increases the fluid loss through urine leading to dehydration which
causes increased thirst and throbbing headache. Alcohol also causes stomach upsets
since it increases the acid secretion by the stomach.

PREVENTING HANGOVERS

• Eat before the drink

• Choose a drink of lower alcohol content

• Do not mix drinks

• Dilute the drink while consuming it or drink a glass or two of water along with the drink
at intervals.

• Do not smoke or chew tobacco more than normal while drinking.

• Have plenty of plain water or a glass of lime juice or a capsule of vitamin C before going
to sleep.

TREATMENT FOR HANGOVER

1. Plenty of Breakfast(white bread with butter, capsicum, tomatoes, cheese or

2. Pain killers

3. Antacids

ALCOHOL OVERDOSE/ABUSE

The concentration of alcohol is 0.3% or above. The patient passes sleep and he responds
only to strong stimuli.

• Dryness of the mouth

• Rapid pulse

• Subnormal temperature

• Pupils may be contracted

Later patient will have

• Slow respiration

• Cold, clammy skin

• Imperceptible pulse
 DRUG
DEPENDENCE

It has been defined as a state, psychological or physical, in which a person has the
compulsion to take a drug on a continuous or periodic basis, either to experience its
pleasurable effects or to avoid the discomfort of its absence. The common drugs of
addiction are :

• Volatile anesthetic solvents commonly toluene, known as glue sniffing

• Alcohol

• Hypnotics (barbiturates, and non-barbiturates such as paraldehyde and chloral hydrate)

• Minor tranquillizers

• Narcotic analgesics, such as opium, morphine, heroin and pethidine

• Stimulants such as amphetamine and drugs of the sympathomimetic group such as

ephedrine and methylphenidate (Ritalin)

• Cocaine,

• Drugs causing distortion of the senses, such as marijuana, LSD and phencyclidine
(PCP, angel dust).

Addition is harmful to the individual because it leads to mental and physical degeneration.
Its also harmful to the society as it leads to moral degeneration. Mental degeneration
manifests itself in careless behavior. The addict disregards conventions, customs and
feelings of others. Physical degeneration manifests itself in careless habits. The addict is
constipated, emaciated due to loss of appetite, and his personal hygiene is very poor. He is
likely to suffer form skin diseases and infections. Impotence and sterility are common.
Moral degeneration manifests itself in crimes, which the addict commits to get the supply of
his drug. He may tell lies, cheat, steal, or resort to any other means. Death from accidental
over dosage and infection is common and suicide is several times more common than in
the general population.
 LSD

Lysergic acid diethylamide, or LSD, is perhaps the best known hallucinogenic drug. First
discovered in the 1940s, it did not come into prominence until the 'flower power and love
culture' period of the late 1960s and early 1970s.

Older adolescents and people in their early twenties are those who use it most frequently,
and although it is still regularly consumed by a significant umber of people, its use is not as
widespread as a number of other illegal drugs. Commonly referred to as 'acid' or 'sugar',
the latter term being used because a drop of LSD solution is sometimes swallowed in a
sugar cube.

Delusions can result so that the LSD user thinks he is able to fly or that he is immune to
normal dangers. The percepatiention of time may be altered and moods may change form
euphoric to intense anxiety or sheer terror.

Although the effects of an LSD 'trip' may last only 6 hours, they can recur months or years
later in a less vivid form known as 'flashbacks'. Persistent late appearing psychosis, which
is very similar to schizophrenia, can occur in some LSD users. A person with latent mental
illness may, by taking the drug, become acutely mentally ill. Other LSD users, overwhelmed
by feelings of anxiety or fear induced by the drug, have committed suicide. There is also
some evidence that birth defects may be induced by women taking LSD during pregnancy.

In a severe case of hallucination and terror while under the influence of LSD, the
experience can be cut short by an intramuscular injection of sedative by a doctor.
 MARIJUANA

Marijuana is produced form the dried leaves, stems and flowering tops of the hemp plant,
Cannabis sativa. It has not accepted medicinal use and is usually smoked as 'reefers'. It is
not a narcotic drug.

As far as can be ascertained the use of marijuana produces no harmful short-term effects
to health. The acute toxicity of marijuana is very low compared with most drugs, but acute
intoxication is possible through smoking, with a loss of psycho motor skills rather like the
effect of alcohol. This acute intoxication certainly reduces the efficiency of the individual.
There is no satisfactory evidence regarding the presence or absence of long-term effects.
 Chapter 5

EXAMINATION OF PATIENT

TOP-TO-TOE SURVEY

Always start at the head and work down; the "top-to- toe" routine is both thorough and
easily remembered. You may need to remove clothing, but bear in mind that, during every
stage of your examination, you should try not to move the casualty more than is absolutely
necessary. Use both hands, and always compare one side of the body with the other,
since any swelling or deformity may be revealed much more clearly.

Start with skull & scalp. Run your hands over the scalp to find bleeding, swelling, or any
soft area or indentation that might indicate a fracture. Handle the head and neck very
gently.

Check for any sign of blood or clear fluid(or a mixture of both) that might indicate damage
inside the skull. Examine both the eyes together, noting the size of the dark circular
centres(the pupils), and whether they are equal in size. Look for any foreign body, wound,
or bruising in the whites of the eyes.

Note the colour, the temperature, and the state of the skin. For example, the closed eyes,
open mouth and noisy breathing of unconsciousness may be accompanied by the pale,
cold, sweaty skin that indicates shock, or the flushed, hot face of stroke or fever. Speak to
the casualty. Ask if he can hear in both ears. Look for blood or clear fluid(or a mixture of
both) coming from either ear canal that might indicate damage inside the skull. Record the
rate, depth, and nature (easy or difficult, noisy or quiet) of breathing. Note any odour on
the breath. Look and feel inside the mouth for anything that might endanger the airway. If
dentures are intact and fit firmly, leave them in place. Look for nay wound in the mouth or
irregularity in the line of teeth. Examine the lips for burns or discoloration, particularly
blueness(which indicates low blood oxygen).

Examine the back and spine. If you have noted impaired movement or sensation in the
limbs, you should not move the casualty to examine the spine. Otherwise, without causing
undue disturbance, gently pass your hand under the hollow of the back and feel along the
spine, checking for swelling and tenderness. Ask the casualty to breath deeply, and
observe whether the chest expands evenly, easily, and equally on the two sides. Check
both collar bones and shoulders for deformity, irregularity or tenderness. Feel the ribcage
for similar abnormalities, and inspect the chest for any wound. Gently feel the soft part of
the abdomen to discover any wound, rigidity, or tenderness. Feel both sides of the pelvic
bone, and gently "rock" the pelvis to discover any sign of fracture. Note any incontinence
or bleeding from the orifices. Examine the upper and lower limbs carefully. Check
movement and sensation in both arms. Ask the casualty to bend and straighten the fingers
and elbows. Take the hands-is the feeling normal ? Note the colour of the fingers. Look for
bruising, swelling or deformity, and for needle marks on the forearm. Look for a bracelet.
Ask the casualty to raise each leg in turn, and to bend and straighten ankles and knees.
Look and feel for any wound, swelling or deformity. Check movement and feeling in all the
toes. Look at their colour-blueness of the skin (cyanosis) may indicate a circulatory
disorder, or cold injury.
 FRACTURES

INCLUDES SPRAINS

Every patient with a definite or suspected fracture or dislocation should receive medical
attention as soon as possible. Transport of the child should be as gentle as possible.

Fractures are often difficult to diagnose in a pt. if in doubt, treat as a fracture of bone or
dislocation of joint. Most fractures in children are incomplete and are called 'greenstick'
fractures,

Symptoms of fractures and dislocations may vary considerably but will include one or
more of the following:

Pain at or near the site of injury made worse by movement of the part.

Tenderness when gentle pressure is applied to affected part.

Swelling due to blood loss around fracture.

Loss of control - deformity of limb, inability to move, or unnatural movement of injured

part.

Coarse bony grating of broken ends of fractured bone - uncommon in young children.

Shock due to blood loss - internal or external.

 GROUND RULES

Immobilize part as soon as possible and in any case before moving the pt too far, using the
pt body and bandages as means of support or using splints and bandages. Raise the
injured part after immobilization to reduce pain and swelling. Attend to asphyxia bleeding
and severe wounds before dealing with fracture.

Move pt as little as possible from site of accident- move only if life(patient's or your
own)is endangered. Move pt by pulling him along, holding him underneath the reduce
pain and swelling Armpits.

BACK AND NECK INJURIES

Move the pt as little as possible to avoid damage to the If medical help is readily available,
do as little as possible,

spinal cord. Comfort the pt and encourage him to lie still Patient should be lying down on
flat, firm surface, at all times. Give only sips of fluid, in case unconsciousness Instruct the pt
to lie still. Cover with a blanket and await should occur. Remove to hospital as soon as
possible and the arrival of medical help watch for shock.
 USE OF BANDAGES

IMPORTANT

Every pt with a definite or suspected fracture or Separate skin surfaces with soft paddingbefore

dislocation should receive medical attention as soon asbandaging- this avoids chafing of skin. Tie

possible. Transport of the pt should be as gentle as splint or on the uninjured side,

possible. Care in use of bandages is essential - they must Check the tightness of
bandaging every 10 minutes be tight enough to immobilize the part but not so tight because
of swelling - especially important in elbow as to interfere with the circulation. injuries- loosen
slightly when necessary.

USE OF SPLINTS

Splints if and when used should be :

Sufficiently rigid and long enough to immobilize the Splints may be improvised from walking
sticks, umbrellas, joint above and the joint below a fracture. broom handles, pieces of
wood, cardboard or firmly folded newspapers or magazines.

They must also be well padded, wide enough to immobilize the part and should be applied
over clothing.
 FRACTURES

TRANSPORTING TO HOSPITAL

If you need to transport the patient to medical help, seek help in preparing the casualty.
Devise a stretcher out of a sturdy board, door etc. place the board, covered with a blanket,
next to the patient who should have been turned onto his side facing away from the
stretcher.

Do not twist the patient during placing onto stretcher.

Move his body as single unit, keeping the head in line with the spine. On a signal from the
person holding the head, roll and lift the patient gently onto the stretcher without twisting
the body or head.

Immobilise the head and spine with suitable padding and bind to stretcher with
bandages,belts, scarves, etc.

DISLOCATIONS

A dislocation is present when a bone has been displaced from its normal position at a joint.
It may be diagnosed when an injury occurs at or near a joint and the joint cannot be used
normally. Movement is limited. There is pain, often quite severe. The pain is made worse by
attempts to move the joint. The affected area is misshapen both by the dislocation and by
swelling (bleeding) which occurs around the dislocation. Except that there is no grating of
bone-ends, the evidence for a dislocation is very similar to that for a fracture. Always
remember that fractures and dislocations can occur together.
1) The wound should be covered both to stop bleeding and to help prevent infection.

2) Do not attempt to reduce a dislocation.

3) A fracture may also be present, in which case attempted manipulation to reduce the
dislocation can be matters worse.

4) Prevent movement in the affected area by suitable immobilization.

5) Look out for impaired circulation and loss of feeling.

6) If these are present, and if you cannot feel a pulse at the wrist or ankle, try to move the
limb gently into a position in which circulation can return, and keep the limb in this
position. Look then for a change in colour of the fingers or toes, from white or blue to
pink.

7) Transport the casualty in the most comfortable position. This is usually sitting up for
upper limb injuries and lying down for lower-limb injuries.
 BANDAGES

FIRST AID KIT

Bandages may be made from flannel, calico and elastic net or special paper. They can
also be improvised from any of these materials or from socks, stockings, ties, belts,
scarves, etc.

Bandages are used chiefly to control bleeding by maianting direct pressure over a
dressing and to retain dressings and splints in position. They may also be used to
prevent and reduce swellings, to give support to a limb or joint, to restrict movement and
assist in lifting or carrying casualties. Never use bandages for padding when other
materials to hand.

APPLICATION: Bandages must be applied firmly enough to control bleeding and

to prevent dressings and splints from slipping. If they are too tight, circulation will
be impeded and the underlying part injured. If the toes or fingers become whitish
or blueish, or become numb loosen the bandage a little.

TYING BANDAGES: All bandages of this type should tied with areef knot, which
does not slip, is flat and is easy to untie. The knot should be placed away from the
injured part and should not cause discomfort.
 FIRST AID KIT FOR LIFEBOAT AND LIFERAFT

4 Standard Dressings No. 14

4 Standard Dressings No.15

6 Triangular Bandages 10 Gauze Bandages 7.5 cm x 4.5 cm

1 Self-adhesive water proof wound dressings Assorted sizes

10 Paraffin Gauze dressings 10 cm x 10 cm

2 Antiseptic Cream 50 gm.

• 1 scissors 12.5 cm

• 12 Safety pins

• 20 Pentazocine Tablets 25 mg

• 20 Mefenamic Acid Capsules 250 mg

• 50 soluble Aspirin Tablets 300 mg

• 50 Paracetamol tablets 500 mg

• 30 Codeine compound Tablets

• 1 First Aid Instructions

(In accordance with Singapore Marine Department Recommendations)

 DRESSINGS

FIRST AID KIT

A dressing is a protective covering applied to a wound to control bleeding, prevent

infection, absorb blood and discharge and prevent further damage.

A dressing should be germ free (sterile), if possible, and able to act as a filter- restricting
entry of germs but allowing air to reach the wound. It must also be very porous in order to
absorb blood and sweat. If sweat cannot evaporate through it, an infection can set in.

It should also be of a non-adherent material so that it will not damage the repairing wound.

Adhesive dressings : These are often called 'plasters'; eg band aids and consist of a pad
of absorbent gauze or cellulose with an adhesive backing which, if perforated, allows sweat
to evaporate. The surrounding skin should be dry before application. When a dressing has
no sticking power of its own it must be held in place by a bandage. Prepared sterile
dressings consist of layers of gauze covered by a pad of cotton wool and come with a roller
bandage to tie them in position. Plain gauze dressings come in a variety of sizes. They
tend to stick to wounds but this can assist in clotting. Vaseline gauze dressings are sold in
squares in sealed packs. They are available in a number of different sizes and they do not
stick to wounds.

Improvised Dressings: These are important because accidents tend to happen when and
where ideal equipment is not available. Dressings may be improvised from clean hankies,
freshly laundered towel or linen or any other clean absorbent material. Keep them in
position with whatever material is to hand.

Handling Dressings : Wash your hands before handling dressings and bandages, and
avoid touching wounds with fingers. Dressings should be covered with adequate padding,
extending well beyond the wound and held in place with a bandage.
CREAM AND OINTMENTS

In general, minor wounds are best cleaned with soap and water-creams and ointments
should be unnecessary. Infected wounds need an antibiotic cream Seek medical advice
if you are in doubt about the use of any application

DRESSINGS

• SAVLON

Antiseptic liquid, a powerful germicide is effective on all types of minor cuts, bruises and
wounds. It does not sting.

Usage

For all types of first aid dilute one part(by volume) Savlon with 3 parts of clean water and
apply on the wound with cotton swabs.

Composition

Contains chlorhexidine, gluconate solution, I.P.

0. 3% V / V & strong cetrimide solution B.P.

• BETADINE

Povidine - Iodine Solution (I.P) Microbicidal solution 5% (W/v) with purified water 9.5

Usage

Degerming the skin post & pre operatively for all surgical procedures, for antiseptic. Rx of
superficial wounds, traumatic injuries and burns.

Action

Betadines - Antiseptic solution has a rapid & prolonged germicidal action against wide
spectrum of bacteria, fungi, protozoa and viruses. In the presence of blood, pus & dead
tissue, its' activity persists as long as the colour remains.

Direction for use :

Should be applied full strength, as often as required, as a paint or wet soak

BLEEDING

BLEEDING (INTERNAL)
 If internal bleeding is suspected, summon immediate medical aid. Internal bleeding may be
suspected if a patient has broken bone or has sustained a sharp blow, knife or bullet
wound to the head, chest or abdomen.

Internal bleeding can also occur as a result of certain medical conditions. If in doubt
consult your doctor immediately.

Symptoms vary according to the location of the bleeding.

• Head : severe headache , dizziness, vomiting, double vision, loss of

consciousness.

• Chest: Bright red foamy blood is coughed up.

• Stomach : Bright, dark or 'coffee grounds' coloured vomit.

• Intestines : Black tar-coloured stools,

• Spleen, liver: No visible bleeding : casualty becomes rapidly shocked and may have
stomach pain.

1. Place casualty at complete rest with legs slightly raised and loosen any tight clothing.
Calm and reassure the casualty. Look for other injuries and treat as necessary.

2. Protect from cold.

3. Give nothing to drink

4. Watch the breathing.

SEVERE EXTERNAL BLEEDING

Massive external bleeding is dramatic

and may distract you from first aid
priorities; remember the ABC of
resuscitation. Bleeding at the face or
neck can obstruct the airways. Rarely,
blood loss is so great that the heart
stops. Remember, too, that shock may
well develop and the casualty may lose
consciousness
Protecting yourself

If you have any sores or open wounds make sure that they are covered with a
waterproof adhesive dressing. Use disposable gloves whenever possible, and wash
your hands thoroughly in soap and water before, and after, treatment.

If bleeding has not stopped after 15 minutes of direct pressure, apply strong pressure at
one of these points between the wound and the heart.

Use a tourniquet ONLY AS A LAST RESORT, if bleeding cannot be stopped and the
situation is life-threatening Bleeding from the nose is very common and does not usually
denote anything serious. It is usually due to a ruptured blood vessel in the septum which
divides. The nostrils. However, it is possible that severe head injuries may cause blood to
trickle from the nose.

Seek immediate medical advice if a fracture is suspected.

1. Place the casualty in a sitting position with head slightly backward.

2. Tell him to pinch firmly the soft part of his nose for about 10 minutes and to breathe
through his mouth.

3. Loosen any tight clothing.

Apply a cold compress over forehead and bridge of nose. Warn the casualty not to blow
his nose for some hours and not to pick it.

If the bleeding does not stop within about 15 minutes, seek prompt medical advice.
 APPENDICITIS

Inflammation of the appendix

SYMPTOMS

 Abdominal pain around the nave (umbilicus).

 Nausea & vomiting

 Low Grade fever.

TREATMENT

Laxatives should be never given in undiagnosed pain moves to the right and is constant
over the abdominal pain area where the appendix lies. Antibiotics & Painkillers after
seeking RMA & advise Bed rest.
 SURGICAL
EMERGENCIES

Head Injuries

A moderate to severe blow on the head will usually cause a degree of concussion even if
there is no damage to the underlying bone

Symptoms include: 'seeing stars'; temporary, Partial or complete loss of

consciousness;Shallow breathing; nausea and vomiting; paleness; coldness and
clamminess of the skin; later loss of memory.

• Lay the pt down and give warmth and comfort.

• Do not give any drinks.

 CONCUSSION

Apply a cold compress to the location of the blow of injury.

If unconsciousness develops place the casualty in the recover position

Observe for signs of more serious; deeper injury to the brain: deepening unconsciousness,
persistent vomiting, double vision or persistent severe headache. Should any of these
develop, remove patient to hospital immediately.

For anything but a small superficial cut or knock to the head, remove pt to the nearest
medical aid. Any tear or cut the scalp or face tends to bleed heavily . Most are not serious
although they look bad. Severe injury to the head can cause fracture of the underlying
bones and in some cases injury to the brain.

• Clean minor and superficial scalp and face wounds with soap and water.

• Compress the bleeding point with clean gauze or cloth until bleeding stops.

Do not give drinks after severe head injuries - sips only can be given.

• Cover, if necessary (and possible), with clean adhesive plaster.

If the injury is more severe, lay the patient down with head and shoulders propped up.
Compress a large clean gauze or cloth lightly over the wound and attach with a
bandage. Do not attempt to clean.

• Watch the level of consciousness Check the pulse: if it stops apply heart compression.

• Watch for signs of shock and, if necessary give the treatment.

HEAD INJURY can be potentially dangerous. Careful examination of the external injury.
Always monitor temperature, pulse, respiratory rate & BP. Local examination of the wound
must be carefully carried out to detect concealed fracture of the skull . Examine the ears,
nose and throat for blood. It should be assumed that the casualty has sustained serious
injuries if he suffers form :

• Unconsciousness

• Blood or sticky clear fluid coming from the ears, nose or throat.

Paralysis.

• If vomiting & headache occurs

• If the patient appears to be confused, drowsy.

• If the pulse rate slows to 60/min.

TRANSFER TO HOSPITAL

Treat the site of the wound, if bleeding profusely apply ice pack i.e. wrap ice pieces in a
handkerchief and place it directly on the wound for 20 minutes to control bleeding.

Give a compression bandage to stop further bleeding. Monitor TPR & BP

Check the pupils for light reflex Note if there is any twitching of the limbs Give
UNCONSCIOUS POSITION to the unconscious patient.

If the bleeding stops, using scissor, cut any hair as near the scalp as possible for a
distance of 5 cm around the wound. Place a dry piece of bandage on the wound and swab
the surrounding scalp with cetrimide 1% solution & dry with sterile swab.

Remove the bandage from the wound place a paraffin gauze dressing over the wound and
on the surrounding scalp. Cover this with sterile swabs and put a RING PAD over the
dressing before bandaging.

SEEK RMA and start with painkillers & antibiotics.

NEVER GIVE MORPHINE IN CASE OF HEAD INJURY.

STRANGULATED HERNIA

The contents of the hernia pouch may occasionally become trapped and compressed by
the opening and it may be impossible to push them back into the abdomen.

The circulation of blood to the contents may be cut off and if a portion of intestines has
been trapped, intestinal obstruction may occur. This is known as strangulated hernia.

CLINICAL FEATURES

• Severe pain in the abdomen

• Vomiting- The higher the obstruction, the more is the vomiting.

• Distention of the abdomen.

• Absolute constipation.

• Evidence of dehydration - Dry tongue, dry skin & sunken eyes.

• Tenderness on palpation of the abdomen

• Pulse rate - more

• Shock (Hypovolaemic or septic)

TREATMENT

• Give painkillers after seeking RMA.

• Bed rest & antibiotics.

• Treat shock if BP falls Transfer to hospital immediately.

 IMPALED OBJECTS

FISH HOOKS

Do not attempt to remove a fish Hook from a pt's face. In other parts of the
body, push the shank through the skin until the point appears.

Cut off the barbed point with a wire-cutting tool.

Retract the remaining shank from wound.

Clean the wound well with soap and water and cover with a clean dressing.
Seek medical advice.
PENETRATING INJURY

Summon or transport to medical help immediately. Do not move a pt off an impaling

object unless his life is in imminent danger. If it is necessary remove him as gently as
possible. Do not attempt to remove the object unless it is obviously smooth and easy to
do so. Otherwise, cut off any long projection 3-5 cm from the skin surface. Try not to
move the object.

 Cut clothing from around wound.

 Place thick dry dressings around the wound and attach with bandaging.

 Watch the pt for signs of shock.

MOUTH INJURIES

BLEEDING
IMPORTANT
Apply direct pressure to tooth socket or
If bleeding has been severe or is not
wound by placing thick gauze or cotton wool controllable, summon medical help
pad firmly in position.
• Clear the mouth of any broken teeth.

TONGUE, CHEEK OR LIP Keep them for possible later replanting.

• Sit the pt down leaning slightly forward.
Compress the bleeding part between the Provide a bowl for the patient to spit into.
finger and thumb, using a clean handkerchief
or gauze dressing until bleeding stops. Ask
the pt to bite down on the pad for 5 to 10
minutes, supporting his chin with his hand.

Do not wash out the mouth as this can disturb the clotting. Do not attempt to plug the
socket.
 EAR INJURIES

CUTS

Ear injuries are commonly due to cuts, foreign bodies and infection. Occasionally they
may be associated with severe head injuries. If such injuries are suspected, seek
immediate medical aid.

Control bleeding form cuts by Dressing gauze or a clean cloth directly over the wound
and elevate the patient's head.

Hold the gauze in place with a bandage around the patient's head.

EAR INJURIES

FOREIGN BODIES / INFECTION

Seek medical aid in the event of foreign bodies proving to be immoveable, and in
cases of infection.

Foreign bodies : Insects may be removed by gently flooding the ear with tepid water
or olive oil. If the insect is alive it may be attracted from the ear by a lighted candle
held 15 cm away. Beads, beans, nuts and other solid objects should be removed by
a doctor.

Infection : Bleeding and pus form the ear usually indicates infection and possible
perforation of the ear drum, place a wad of cotton wool loosely in the ear and hold in
place with a bandage.

Infection : Bleeding and pus from the ear usually indicates infection and possible
perforation of the ear drum. Place a wad of cotton wool loosely in the ear and hold in
place with a bandage.
 EAR INJURIES IMMEDIATE

IMPORTANT

All eye injuries are potentially serious and will require medical attention.

Remove the foreign body from white of eye with the corner of a clean
handkerchief or a moistened wisp of cotton wool. If under the lower lid, pull the
lid down and remove foreign body as shown.

If this is unsuccessful or the object is under the upper lid, ask the
patient to blink with the eye under water.
CHEMICALS IN EYE

Holding the eyelid open, immediately flush the eye with gently running tepid water for 3
minutes. Make sure that the flow of water is away from the other eye. Cover the eye with
gauze held in place with a bandage. And seek medical help.

Lay the patient down and give comfort and reassurance. Cover both eyes with gauze
padding held in place with a light bandage around the head.

Transport to hospital immediately.

 CHAPTER 7

BURNS, SCALDS AND ACCIDENTS CAUSED ELECTRICITY AND EFFECTS OF HEAT

AND COLD

Thermal burns are caused by dry heat(e.g. fire & hot metal) Scalds result from moist heat
e.g. hot liquids or steam Chemical burns are caused by acids & alkalis

Electrical burns are clinically evident at the point of entry and exit, the latter being more
severe.

1) Wallace's Rule of Nine -

For clinical purpose the surface area of the burn is estimated by the Rule of Nines.

2) The Depth of the burn -

• First Degree burns

Only the epidermis, superficial layer of the skin in involved. There is redness with
burning sensation.

• Second Degree burns superficial second degree burns :

The epidermis & the superficial layer of the dermis is involved.

This presents as a blister formation, considerable swelling & weeping of fluid.

• Deep Second Degree :

The epidermis & dermis (full thickness) are involved, may not be easy to distinguish from
third degree burns immediately after the injury. Pain may be severe because of
damage to the nerve endings.
Third Degree Burns ;

Involve the whole thickness of the skin and may extend to underlying fat &
muscle. The skin may be charred, black or dark brown, leather or white
according to the cause of the burn. Pain may be absent due to destruction of the
nerve endings.
 ALWAYS EXAMINE CAREFULLY

Whether the patient has

(a) Soot on his teeth

(b) Singed hair in the nostrils

(c) Cherry red oral mucosa

(d) Circumferential burns (of the neck)

(e) The burns involving face and genitalia, and large burns around joints.

(f) Third degree burns with any other con-comitant injury or disease.

(g) Burns over 18% of the body surface (in an adult) and 10% in children and persons
above 40 years of age.

If so, TRANSFER TO HOSPITAL IMMEDIATELY

FIRST AID

• Remove the burnt clothing. Do not pull those tags of

cloth stuck to the burnt surface.

• Remove all the jewellery.

• Immerse the burnt part of the body in water or pour

water over the burnt area.

If the burns is of FIRST DEGREE

Treatment includes pouring water over the wound, dabbing it dry with a swab and apply.

OINTMENT SIVER SULPHADIAZINE (Silverex)

Or

PETROLEUM JELLY Or

ZINC OXIDE If the burns is of SECOND DEGREE,

Run cool water over area of burn

 WOUND DRESSING IS IMPORTANT

BURN WOUND DRESSING

• Wear on sterilized gloves

• Keep the dressing trolley ready with an assistant to help you do the dressing.
The assistant should also wear on gloves.

• Treat the wound with saline/warm water to remove all the dirt or mud.

• Clean the area around the wound first with SAVLON or 1% CETRIMIDE
SOLUTION. Then clean the wound with the same solution. Cleansing should
be done with a piece of bandage (gauze piece) by holding it in a needle-
holder and not with a cotton swab and should be carried out from centre
(wound) to the periphery.
IN CASE OF THIRD DEGREE BURNS

The management of burn patients may be conveniently described under 3

headings-

1. Immediate therapy

2. Treatment for the burn wound.

3. Other supportive measures.

IMMEDIATE THERAPY

a) Emergency Respiratory Care :

Exposure to heavy smoke may lead to carbon-monoxide poisoning.

Treatment consists in administration of 100% oxygen by nasal catheter or

through endotracheal tube.

b) Relief of Pain

• The burnt area is kept covered with sheets to prevent irritation.

• Exposure to cold is avoided as this induces pain

• Sedatives/ pain killers are administered intravenously every 4-6 hours. For
adults PETHIDINE OR MORPHINE and for children

c) Intra-venous Fluid Resuscitation

All adults with burns exceeding 18% and children with burns above 10%
require fluid resuscitation.

RINGER'S LACTATE is the IV fluid of choice.

AVOID SUGAR CONTAINING FLUIDS.

• The rate of IV fluid flow in an adult is 2 to 4 ml of fluid x% of burnt surface x

kg body weight

• The urinary output in an average adult must be 35 to 50 ml/hour.

d) TETANUS PROPHYLAXIS

e) Antibiotics
 Chapter 8

MEDICAL CARE OF RESCUED PERSONS INCLUDING DISTRESS, HYPOTHERMIA,

COLD EXPOSURE, TEMPERATURE, PULSE, RESPIRATION, BLOOD PRESSURE
AND SICK QUATERS.

SICK QUARTERS

• Wherever possible a patient sufficiently ill to require nursing should be in the ship's
hospital or in a cabin away from others. RESPIRATORY RATE (R/R)
Age Respiration Rate

• Adequate ventilation of the sick quarters is 2-5 years 24-28/min

important. Adult male 16-18/mi n

Adult female 18-2 0/m in

• Dust accumulation is avoided.

• A receptacle with a cover/lid is provided

to the patient if he has cough with
sputum.
• A kidney tray to collect the vomit us in; a
urine pot and a bed pan is kept by the
bedside.
• TPR,BP chart and flu it input-output chart
is kept ready.
Always count respirations for one full
minute, noting any discomfort in breathing in
or out. The pulse rate will usually rise about
4 beats per minute for every rise of 1
respiration per minute. The 4:1 ratio will be
altered in chest diseases such as
pneumonia which can cause a great rise in
respiration rate.

• Dietary intake will depend on the patient's illness and can be recorded.

• Check and record if bowel have moved or not.

 BLOOD PRESSURE

Blood pressure is measured in millimeters of mercury, and represents the

pressure of blood within the vessels.

Because of the pumping action of the heart, the pressure levels have a wave form,
falling in between heart beats. The peak pressure is called systolic pressure, while
the lowest point represents the diastolic pressure. Thus blood pressure is
recorded as two numbers -e.g. 120/80- the first(higher) pressure being the
systolic, and the second being diastolic.

The normal range of blood pressure is 100 to 140 for systolic, and 70 to 90 for
diastolic pressures. Older people tend to have a slightly higher diastolic pressure,
usually between 90 and 95 millimeters of mercury. Their systolic pressure may
extend up to 160 mm.

HOW BLOOD PRESSURE IS MEASURED

Blood pressure is measured with a sphygmomanometer and a stethoscope. An

inflatable cuff is usually wrapped around the upper arm (but can be wrapped
around the thigh,) and then pumped up.

The cuff is connected to a pressure measuring device, and once the pressure is
higher than the systolic value, no blood flow occurs.
When the pressure applied by the cuff is less than the diastolic pressure, blood
flow is undisturbed. In both these situations no sounds will be heard by a
stethoscope placed over the artery just below the cuff.

Between these two pressures, however, as the cuff is being deflated slowly there
will be some narrowing of the blood vessel and the blood flow will be turbulent.
This turbulence produces a clearly audible sound. Thus the pressure at which
these sounds being is the systolic pressure and the pressure when they cease is
the diastolic pressure.

HYPOTHERMIA

Hypothermia is the term given to the condition when deep body temperature is
lowered to less than 35°c(95°F) when normal body function will be impaired. Loss
of life may occur when deep body temperature falls below 30°c(86°F).

Causes

The usual causes among seafarers are immersion in the sea, or exposure to cold
air while in a survival craft, in colder water death from hypothermia can occur in
less than an hour.

Diagnosis

Hypothermia should always be suspected in every individual rescued at sea. If

the casualty is unconscious, there are no reflexes and the pupils are dilated. The
respiratory rate is very slow with two or three movements a minute. The pulse is
imperceptible and heart sounds cannot be heard even with a stethoscope. Death
by hypothermia is then defined as being the failure to revive the casualty by re-
warming.
TREATMENT

a) Removal of all wet clothes and replacement with dry clothes or blankets.

b) Hot sweet drinks

c) Rest in a warm environment not exceeding 22°c(72°F) (normal room

temperature) are also recommended.

d) NEVER GIVE ALCOHOL

e) If the survivor is not shivering but is semi-conscious, unconscious or

apparently dead, slow rewarming is essential. Never attempt rapid rewarming
by immersion in a hot bath except on medical advice.

The following measures will be necessary to preserve life :

a) On rescue always check the survivor's breathing and listen for hear sounds. If
the survivor is not breathing, ensure the airway is clear and start artificial
respiration immediately (mouth to mouth or mouth to nose). Attempt are
resuscitation should be continued until medical advice can be obtained, or for
at least 30 minutes.

b) Prevent further heat loss due to evaporation or exposure to the wind.

c) Do not massage the limbs.

 d) Avoid all unnecessary handling, even the removal of wet clothing.

e) Enclose the survivor in a plastic bag of blankets or preferably both. The

blankets should not be warmed, and it is important that the head, but not the face,
is well covered. Place in a room that is not too warm (15°-20°c) (59°-70°F). Never
attempt to give any fluids by mouth to an unconscious casualty. When
consciousness is regained never give alcohol if the survivor is breathing but
unconscious, lay him in the unconscious position. When consciousness has been
fully regained give a warm sweet drink.

f) Conscious survivors suffering from hypothermia should be laid on their side

and, whenever possible, in a slightly head-down attitude.

g) In survival craft, seriously affected survivors should be placed in close

proximity to warmer occupants, to permit transfer of body heat.

h) When spare clothing or blankets or survival bags are available they should be
given to those most affected. Huddling together under blankets or any other

FREEZING COLD INJURY - FROSTBITE

Frostbite is the term given to the condition when tissue fluids freeze in localized
areas of the body; the hands, face and feat are particularly susceptible.
CAUSE

Exposure, particularly of bare skin to sub-zero temperatures, especially when combined

with air movement. Look-outs in life rafts or survivors in open boats are particularly prone
to this injury

Diagnosis

The signs are :

a) Extreme waxy pallor of the skin;

b) Initial local tingling and stiffness when it is difficult to wrinkle the face or wriggle
affected toes or fingers;

c) Complete absence of sensation in the area effect ; and

d) Local hardness due to freezing of the flesh. PREVENTION

If bare skin has to be exposed to the elements, the periods of exposure should be kept
to a minimum and freezing winds particularly avoided. Moderate exercise and massage
at an early stage will help to prevent the onset of cold injury. Do not smoke ; smoking
reduces the blood supply to the hands and feet.

TREATMENT

On detection of the above signs, immediate steps should be taken to re-warm the frozen
parts before permanent damage occurs.

i) Get out of the wind.

ii) Re-warm the frozen area by applying it to a warmer part of the body, e.g. hands
under armpits, cupped hand over cheek, nose, ear, etc.

iii) Once freezing has occured do not rub or massage affected areas.

iv) When treatment has been ineffective the skin dies and becomes black. If this occurs
dry dressings should be applied to the affected part.
 NON FREEZING COLD INJURY IMMERSION FOOT

This is a term given to the condition when the temperature of local tissues in the limbs
(usually the feet) remains sub-normal but above freezing for a prolonged period. It is
commonly encountered by ship wreck survivors who have been adrift and cold for
several days. Usually the feet have been wet and immobile, but this injury can occur in
conditions. Other contributory factors are tight footwear and sitting still with the feet
down for prolonged periods.

DIAGNOSIS: Feet become white, numb, cold and frequently are slightly swollen. When
returned to the warmth, the feet become hot, red, swollen, and usually painful.

PREVENTION: Every effort should be made by survivors to keep their feet warm and
dry

i) Shoe laces should be loosened ;

ii) The feet should be raised and toe and ankle exercises encouraged several times a
day.

iii) Shoes should be removed and feet kept warm by placing them under the armpits,
but outside the clothing, of another occupant of the life-raft or boat.

iv) Unwanted spare clothing may be wrapped round the feet to keep them warm.

v) Smoking should be discouraged.

TREATMENT: After rescue every effort should be made

i) To avoid rapid re-warming of the affected limbs.

ii) Care should be taken to avoid damaging the skin or breaking blisters.

iii) Do not massage affected limbs.

Elicit a proper medical history from the patient about his present illness.

R/o past h/o hypertension, lung disease and diabetes mellitus, and drug allergy.

a) Jot down the general common features(skin e.g. any discoloration, hair, spine,
nails and level of consciousness)

b) The vital parameters (TPR& BP)

c) Your findings o/e of respiratory system, cardio vascular system and abdomen
(gastro-intestinal system)

Always report the Rx that you've started with and keep with you the list of medicines
 CHAPTER 9

RADIO MEDICAL ADVICE

This is available by radio telegraphy or by direct contact with the doctor by radio telephony
from a number of ports in all parts of the world. It may, on occasion, be obtained from other
ships in the vicinity who have a doctor on board.

Elicit a proper medical history from the patient about his present illness.

R/o past h/o hypertension, lung disease and diabetes mellitus and drug allergy.

a. Jot down the general common features(skin e.g. any discoloration, hair, spine, nails and
level of consciousness)

b. The vital parameters (TPR& BP)

c. Your findings o/e of respiratory system, cardio vascular system and abdomen (gastro-
intestinal system) Always report the Rx that you've started with and keep with you the
list of medicines and equipments available on the ship.

• Jot down the instructions given by the doctor and REPEAT THEM BACK TO THE
DOCTOR.

INFORMATION TO BE READY WHEN REQUESTING RMA

Part A- In the case of Illness

I. Routine particulars of the ship :

Name, call sign of the ship with date and time (GMT),

port of destination and/or nearest port is

and is ___

Hours/days away.

II. Routine Particulars about the patient/casualty :

• Full name of the casualty beginning with surname

• Age, sex, job on board (occupation ) & the rank.

III. Routine particulars about the illness:

 Mention the patient's chief complains (illness)

• Since past how many days patient has been suffering form each of the
 complaints/illness

• Whether the onset of symptoms was sudden or gradual

• Mention significant past history & family history (if relevant)

• Any Rx taken by the patient, if yes (specify for what, since how many days and the
doses/day)

• Whether the patient is a chronic alcoholic or smoker

• Are the sleep, appetite, urinary and bowel habits normal ?

IV. Results on Examination (O/e) of the patient:

• Whether the patient is conscious, co-operative, well-oriented in time and space.

• TPR & BP

• Skin, hair, nails, spine & joints

• Swelling in the feet, yellow discoloration of the sclera.

• Swollen & painful glands in the neck, armpit or groin

V. Provision diagnosis made by you

VI. Treatment

• Rx (Treatment) given by you. MENTION THE NAME OF THE ANTIBIOTIC OR ANY

DRUG GIVEN WITH DOSES/DAY

• How has the patient responded to the Rx given.

VII Complications.

• What complications you anticipate ?

• What do you think you need to be advised on ?

VIII Comments by the Radio Doctor:

(Type or write them down, repeat them back to the doctor)

PART B - In case of INJURY

Give the particulars of ship & casualty as mentioned in PART-A (I & II)

III HISTORY OF INJURIES

 • How did the injury (exactly) occur?

• How long ago was that and whether accidental?

• Ascertain whether it was caused by sharp or blunt object

• What are the patient's chief complains?

• Significant past history of illness/injury.

• Mention the medicines if in case the patient has been taking them (dose/day)

• Did the patient lose consciousness (though momentary), was under the influence of
alcohol/ drug ?

• Does the patient remember the incidence of injury entirely ?

IV. RESULTS OF EXAMINATION

Whether the patient is conscious, co-operative, well-

oriented in

time and space

• TPR & BP

• Skin, hair, nails, spine & Joints

• Number of injuries, mention the SITE & NATURE (contused lacerated

wound/bruise/stab/incision/ burns/gun-shot, etc.)

• Length, breadth & depth of the injury Bleeding (mild/heavy)

• SIGNS OF HYPOVOLAEMIC SHOCK

• Blood in urine or vomits(if occurred)

V. TREATMENT

 Mention the first-aid carried out

• Name of the PAIN KILLERS / ANTIBIOTICS USED

• Patient's response (whether positive)

VI. COMPLICATIONS

• What complications you anticipate ?

 What do you think you need to be advised on ?

VII. COMMENTS BY THE DOCTOR

(Tape or write them down and repeat them back to the doctor)
 Chapter 10

PHARMACOLOGY STERILIZATION GROUPS OF MEDICINES ACCORDING TO THE

SITE AND

NATURE OF THEIR ACTION

A. For external use

Dermatlogical Benzoic and salicyclic acid Antidotes atropoine sulfate injection charcoal,
ointment activated, powder
medicines
calamine iltion hydrocortisone dimercaprol injection
1% ointment

ichthyol and glycerine ointment naloxone hydrochloride injection

lindane cream (for scabies) Antiepileptics diazepam tablets diazepam injection

phenobarbital tablets

miconazole nitrate vaginal amoebicides metronoidazole tablets

cream mineral oil petrolatum
white talk (talcum powder)

zinc oxide paste Anthelminthic piperazine tablets

drugs (to treat
worm
infestation)

Surgical alcohol, rubbing,70% cetrimide antibacterial ampicillin capsules benzylpenicillin

1% solution iodine 2.5% injection.
disinfectants solution drugs
Other aluminium acetate powder (for doxycycline tablets
making Burrow's solution)
medicines insect repellant.

potassium permanganate erythromycin tablets

phenoxymethylpenicillin potassium
tablets procaine benzylpenicillin
injection spectinomycin
hydrochloride injection
sulfamethoxazole + trimethoprim
tablets.
 B. For Internal use

Anaesthetics, local lidocaine 1% injection tetracycline hydrochloride

capsules

Analgesics (pain acetyisalicylic acid tablets morphine antimalarial drugs chloroquine tablets proguanil
killing drugs) sulfate injection paracetemol tablets tablets quinine dithdrochloride
injection, quinine sulfate tablets.

Antiallergics Chlorphenamine maleate tablets Blood substitutes dextran and sodium chloride
chlorphenamine maleate injection injection.

Cardiovascular drugs glyceryle triniate tablets immunologicals tetanus immune human globulin
(for treating heart epinephrine injection furosemide (immunoglobulins injection tatanus toxoide injection.
diseases and blood tablets. and vaccines)
circulation problems)

Childbirth, drug used ergometrine maleate injection Psychotherapeutic amitriptyline tablets

in drugs (for mental
illness)

Chlorpromazine hydro chloride

tablets

Diagnostic agents fluorescein sodium ophthalmic chlorpromazine hydrochloride

strips injection

diazepam tablets diazepam

injection

Diuretics (drugs furosemide tablets Respirtory tract,

increasing the
secretion of urine)

Ear medicaments Aluminium acetate eardrops anti-asthmatic aminophyline suppositories

drugs
tetracycline ear-drops ephedrine sulfate capsules

epinephrine injection salbutamol

oral inhalation

Eye medicaments eye anaesthetic drops eye anti cough-controlling codeine sulfate tablets
infective drops eye tetracycline
ointment drug

eyewash or eye-irrigation solution sedatives phenobarbital tablets

Fluorescein sodium ophthalmic
strip (for diagnosis)
 MEDICINES RECOMMENDED TO BE CARRIED ON BOARD SHIPS FOR
TREATMENT OF PEOPLE EXPOSED TO TOXIC SUBSTANCES

Name Recommended standard Format Quantity

Aluminium hydroxide, or unit

ig tablet 100
mangesium trislicate
Aminophylie * 360 mg suppository 60
Ampicllin * 500 mg Capsule 100
Amylnitrite 0.17 mg in 0.2 ml ampoule 96
Ascorbic acid(Vitamin C) * 1g tablet 120
Ascorbic acid(Vitamin C) 500 mg in 5 ml ampoule 20
Atropine sulfate * 1 mg in 1 m ampoule 200
Calcium gluconate 2% 25 g tube 6
Calcium gluconate 19 tablet 10
effervescent *
Charcoal activated * 5g sachet or powder 10

chlopromazine * 10 mg in 1 ml ampoule 20
Chlorpromazine * 25 mg in 1 ml ampoule 80
Diazepam * 10 mg in 2ml ampoule 60
Dimercaprol * 100 mg in 2 ml ampoule 160
Ethyke alcohol 10% solution 500 ml bottle 4
Fluorescein sodium 1% or 2% eye test strip 100
*Furosemide 20 mg in 2 ml ampoule 40
Furosemide * 40 mg tablet 80
Glucose 500 g powder 1
Macrogol 300 1 litre bottle 2
 Methylene blue 1% 10 ml ampoule 40
Metoclopramide hydrochloride 10 mg in 2 ml ampoule 60
Morphine Sulfate * 15 mg in 1 ml ampoule 30
Naloxone hydrochloride * 0.4 mg in 1 ml ampoule 30
Paracetamol * 500 mg tablet 120
Phytomenadione (Vitamin K1) 10 mg in 1 ml ampoule 4
Sulfamethoxazole + trimethoprim 400 + 80 mg tablet 50
*
Tetracycline hydrochloride, 1%, 4g tube 10
eye ointment *

*This drug is also recommended for inclusion in the basic ship's medicine chest.

However, recommended quantities may be different.

 CHAPTER 11

CARDIAC ARREST, DROWNING AND ASPHYXIA

ANGINA PECTORIS

It is a severe chest pain usually brought on by exertion, angina pectoris is a result of

blood flow to the heart muscle inadequate to meet its needs for removal of products of
metabolism.

Severe emotional upsets and other conditions which increase the heart rate may also
initiate angina attacks.

Predisposing Factors:

 Age above 35 Years

 Sex – more common in males

 Obesity

 Diabetes

 Cigarette smoking & Alcohol

 High Cholesterol (Oily & fatty) diet

Always rule out chest pain due to

1. Lung Disease

2. Flatulence with abdominal Discomfort

3. Trauma to the chest

Symptoms: Severe chest pain felt as a tight band across the front of the chest.
Pain may radiate to the left arm and left part of the jaw or to the right arm, in a few
cases.
CAUSES

Deposition of cholesterol(fats) in the inner aspect of the blood vessels which leads to
narrowing of the lumen of vessels supplying the heart.

PRECAUTIONARY MEASURES

Weight Reduction Avoid cigarette smoking Reduce fatty diet.

Avoid Emotional upsets.

Rx

A) T.GIyceryl Trinitrate (0.6mg)

Is administered SUBLINGUAL (BELOW THE TONGUE SEEK RMA before giving

another tablet if chest pain is not relieved.

If the blood clot in the coronary arteries is carried to the blood vessels supplying the
brain along the flow. It will block the blood supply to the brain leading to oxygen
deficiency to the brain. This may present as

1) Convulsions

2) Paralysis(stroke)

3) Coma

4) Death

B) Morphine injections by IM route

C) 02 administration at the rate of 10— 15 lit/min

DIABETES: An incurable disease, diabetes mellitus generally simply called diabetes, is

caused by inadequate levels or reduced effectiveness of insulin. Thus hormone is
produced by special cells in the pancreas, a gland that is situated in the abdomen.

Insulin is essential for the proper metabolism of blood sugar and the maintenance of blood
sugar level. The blood which is 130mg before intake of food and 160mg after having food.
 ASPHYXIA

SYMPTOMS AND CAUSES SYMPTOMS OF ASPHYXIA

Breathing : Rate, depth and difficulty increase and later breathing becomes noisy
with frothing at the mouth. Finally, breathing stops.

Congestion : The head and neck, face, lips and whites of eyes become red and
eventually turn purple. Finger and toenail beds become purple.

Heartbeat : Becomes fast, then weak and finally stops.

Unconsciousness : Drowsiness is followed by stupor, then unarousable coma

ending in death.

The commonest causes of asphyxia are spasms of breathings tract, obstruction of the
airway, suffocation and conditions which prevent oxygen use by the body. Spasms
may be caused by food, water, smoke, irritant gases, asthma and some chest
infections.

Obstruction of the airway may be caused by swallowed foreign bodies, food, teeth,
blood, vomit,

Suffocation may be caused by pillows and plastic bags and oxygen use may be
impeded by car exhausts, gas supplies,chemical fumes and smoke.

Nasal cavity Nose hairs Pleural membrane Diaphragm Muscles attached to diaphragm

In normal breathing air passes through the windpipe into the lungs. The
Diaphragm, during inhaling, moves down and flattens out causing a partial
vacuum in the lungs.

Air is drawn in to equalize the pressure. During exhaling, the elastic tissue of the wall
of the lungs enable them to deflate. Asphyxia occurs when an adequate supply of
oxygen is not available to the bodie's blood supply.

It may be due to a shortage of oxygen in the air breathed or to inadequate functioning of

the heart and lungs