First Aid

1. First Aid Personalizing your approach to medical emergencies and more minor medical problems Kathie King MD FHYC Fleet Surgeon October 15, 2010 Delle Curry chair of education committee Rob Skrotsky, Bob Fortenbaugh mentors in preparation Welcome to Blackbeard members Rob and Chris Skrotsky�s first aid kit Doug helped in preparation, technical assistanceDelle Curry chair of education committee Rob Skrotsky, Bob Fortenbaugh mentors in preparation Welcome to Blackbeard members Rob and Chris Skrotsky�s first aid kit Doug helped in preparation, technical assistance

2. Please contribute and ask questions Experience managing own & family�s medical problems; may be more expert in some areas (ex snakes) Discussion of medical topics that I think are important (no hands-on practice; no certification) Courses in CPR and First Aid available through Red Cross and Heart Association (Carolina East) Current CPR skills needed by ~20 FHYC members to maintain our AED programPlease contribute and ask questions Experience managing own & family�s medical problems; may be more expert in some areas (ex snakes) Discussion of medical topics that I think are important (no hands-on practice; no certification) Courses in CPR and First Aid available through Red Cross and Heart Association (Carolina East) Current CPR skills needed by ~20 FHYC members to maintain our AED program

3. What is First Aid? Medical Emergencies Non-emergency First Aid First response to situation that requires advanced care Life or Limb-threatening Bleeding Airway Cardiac Arrest Allergic reactions Broken bones Minor medical needs May need advanced care Minor wounds Minor allergies Common medical problems treated with over-the-counter medications Common injuries 2 types of first aid: emergencies that require advanced care quickly more minor issues that occur in everyday life, that we are used to managing2 types of first aid: emergencies that require advanced care quickly more minor issues that occur in everyday life, that we are used to managing

4. �The first thing about First Aid is to be careful, so First Aid can be avoided!� Advice from a laypersonAdvice from a layperson

5. Safety Situational awareness (hazards in environment) Temperature (heat, cold), sun exposure (sunscreen) PFDs, lifelines, bow and stern pulpits, grabrails Appropriate clothing including footwear Boat itself Falling on the boat Caught between boat and another object Falling overboard FHYC website: �boating health and safety� Preparation and situational awareness is at the core of First Aid Warning: odds and ends of anecdotes throughout this discussion Be sure equipment is in good order- rickety bow and stern pulpits, stanchions that break off in races Appropriate footwear- a broken toe can ruin a cruise Boat itself- falling into hatches, the woman on the Nordhavn who was skewered by fending off a sailboatFHYC website: �boating health and safety� Preparation and situational awareness is at the core of First Aid Warning: odds and ends of anecdotes throughout this discussion Be sure equipment is in good order- rickety bow and stern pulpits, stanchions that break off in races Appropriate footwear- a broken toe can ruin a cruise Boat itself- falling into hatches, the woman on the Nordhavn who was skewered by fending off a sailboat

6. Preparation Where are you cruising? What are you likely to encounter? What will you need? How easily can you obtain supplies? How can you obtain help in an emergency? Basic considerations about health while cruising Preparing yourself (what you know; do you need books or courses?), bringing supplies (first aid kit), where and how you�ll get help Special circumstances in certain locations, ex., the Bahamas- BASRA protocolsBasic considerations about health while cruising Preparing yourself (what you know; do you need books or courses?), bringing supplies (first aid kit), where and how you�ll get help Special circumstances in certain locations, ex., the Bahamas- BASRA protocols

7. Adapting � from land to a marine environment Your knowledge about your medical conditions Your knowledge about general medical conditions and First Aid Resources: Books Courses/training Subscription medical services Evacuation insurance (Divers Alert Network) Most medical info is about treatment on land- you have to adapt to conditions on the water You bring your medical conditions with you You have good baseline knowledge! Look for areas that you want to supplement- content areas; books: style/layout that are easy for you to use Depending on where you are traveling and your medical issues, you may want to engage a subscription medical service that you can call with questions or problems, or obtain evacuation insurance.Most medical info is about treatment on land- you have to adapt to conditions on the water You bring your medical conditions with you You have good baseline knowledge! Look for areas that you want to supplement- content areas; books: style/layout that are easy for you to use Depending on where you are traveling and your medical issues, you may want to engage a subscription medical service that you can call with questions or problems, or obtain evacuation insurance.

8. Your medication/treatment regimen Supplies for exacerbations/complications Copies of your baseline EKG and other medical records Supplies for expected problems (sunburn, minor cuts, environmental hazards) Supplies for unexpected problems (accidents, illnesses) Are your immunizations up to date, appropriate for your travel? (ex. travel clinic @ Duke for people planning to travel) Personalizing your First Aid kit Rob and Chris Skrotsky�s first aid kit- goal to treat medical conditions for 36 hr if necessary Your physician can recommend medications and supplies for you to bring with you (usual medications; supplies for expected and unexpected problems- ex., sunscreen and aloe or pain med for fractures) Why bring baseline EKG and specialized tests: you can help your doctor get to an accurate diagnosis faster and avoid unnecessary tests and work-up Travel clinic- immunizations and medical supplies specific to your area of travel (ex., diarrheal meds, malaria prophylaxis)Rob and Chris Skrotsky�s first aid kit- goal to treat medical conditions for 36 hr if necessary Your physician can recommend medications and supplies for you to bring with you (usual medications; supplies for expected and unexpected problems- ex., sunscreen and aloe or pain med for fractures) Why bring baseline EKG and specialized tests: you can help your doctor get to an accurate diagnosis faster and avoid unnecessary tests and work-up Travel clinic- immunizations and medical supplies specific to your area of travel (ex., diarrheal meds, malaria prophylaxis)

9. Summoning help Other cruisers- VHF or SSB, not your cell phone Coast Guard- channel 16 Leave �how to get help� laminated instructions at the helm, should your guests need to get help for YOU! You want everyone around to listen in When the Coast Guard asks you to switch to channel 22, your audience will switch too (the person in a SeaRay who just waked you may be willing to take someone to the hospital at 50 knots!) *ask passengers and/or crew on your boat to disclose medical problems (inform them about your issues too) ex., person with diabetes who needs to eat at scheduled intervals conditions that may affect ability to move on boat or self-rescue other issues?You want everyone around to listen in When the Coast Guard asks you to switch to channel 22, your audience will switch too (the person in a SeaRay who just waked you may be willing to take someone to the hospital at 50 knots!) *ask passengers and/or crew on your boat to disclose medical problems (inform them about your issues too) ex., person with diabetes who needs to eat at scheduled intervals conditions that may affect ability to move on boat or self-rescue other issues?

10. Common Medical Problems Heart Attack Stroke Seizure Allergic Reaction Diabetes Nausea/Vomiting Heat-related illness Cold-related illness Fractures Wounds Bleeding Head/neck injury Sprain/strain Burns Snakebites Bites and stings Poison oak/ivy/sumac This is what we will be talking about today- common medical and surgical problems I will mention key points; please ask questions and make commentsThis is what we will be talking about today- common medical and surgical problems I will mention key points; please ask questions and make comments

11. Heart Attack Symptoms: chest pain, shortness of breath, nausea, pain radiating to arms or jaw, sense of impending doom, ashen skin, weak or irregular pulse, sweating, fainting or dizziness, collapse. Symptoms are different in women and in people with diabetes Treatment must be given within 6 hours of onset of symptoms Encourage victim to rest, half-sitting, knees bent, position of comfort Have aspirin available (ask: allergic to ASA or is it contraindicated?) 2 baby-ASA or 1 adult-ASA Does the victim have/use nitroglycerin? If the victim becomes unconscious, get advanced help immediately Be prepared to give rescue breaths and chest compressions Classic symptom �I feel like there is an elephant sitting on my chest� SOB, pain radiating down arms, indigestion; jaw or shoulder pain; women & people with diabetes- subtle symptoms *Recognizing the difference btwn heart attack and stroke *Can call Coast Guard and they can patch someone through through to advise you ASA- contraindications: allergy (airway problems), bleeding or stomach disorder Ask person if they have NTG and if they think that they should use it Treatment within 6 hours to preserve heart muscleClassic symptom �I feel like there is an elephant sitting on my chest� SOB, pain radiating down arms, indigestion; jaw or shoulder pain; women & people with diabetes- subtle symptoms *Recognizing the difference btwn heart attack and stroke *Can call Coast Guard and they can patch someone through through to advise you ASA- contraindications: allergy (airway problems), bleeding or stomach disorder Ask person if they have NTG and if they think that they should use it Treatment within 6 hours to preserve heart muscle

12. Stroke Symptoms: Problems with speech or swallowing, weakness or loss of movement in limbs, headache, confusion or loss of consciousness Cincinnati stroke scale Facial droop Arm drift Abnormal speech �Brain attack� Maintain open airway, no food or drink, arrange transport ASAP Treatment must be given within 3 hours CT scan in ER (embolic vs. hemorrhagic) Stroke as a �brain attack� with same urgency as heart attack If the cause of the stroke is a clot, they�ll want to give clot-busting agent within 3 hr Time window for special treatment is 3 hours (otherwise risk is higher than benefit from treatment) Can be other reasons for appearance of stroke: ex., stroke symptoms from low blood sugarStroke as a �brain attack� with same urgency as heart attack If the cause of the stroke is a clot, they�ll want to give clot-busting agent within 3 hr Time window for special treatment is 3 hours (otherwise risk is higher than benefit from treatment) Can be other reasons for appearance of stroke: ex., stroke symptoms from low blood sugar

13. Seizure Symptoms: loss of consciousness, rigidity, convulsive movements During the seizure: protect the head, ease the fall, do not restrain After: open the airway, place in �recovery � position (log-roll victim onto side with upper leg forward, their hand under face to prop open their airway) Post-seizure confusion Medical help if new seizure, unconscious >10 minutes, or recurrent seizures; may need airway management new-onset vs. established pattern; causes: tumor; low blood sugar Worst thing about seizures is that people are afraid of seizures and afraid to help a person with a seizure Protect the person having a seizure- protect from falling, protect their head, keep their airway open Seek help if new seizure, recurrent seizures, or prolonged unconsciousnessWorst thing about seizures is that people are afraid of seizures and afraid to help a person with a seizure Protect the person having a seizure- protect from falling, protect their head, keep their airway open Seek help if new seizure, recurrent seizures, or prolonged unconsciousness

14. Allergic reactions Causes: bee-stings, drugs, shellfish, peanuts, milk, egg (contact by ingestion, injection, skin, or inhalation) Symptoms: red, blotchy skin; puffy eyes; swelling of throat and tongue, trouble breathing, signs of shock If mild: consider antihistamines, topical anti-itch or steroids If severe: call 911, EMS, or Coast Guard Epi-Pen (epinephrine) a mild reaction can become severe, within minutes! Epi-Pen information: http://www.epipen.com/~epipen/page/english-cable--how-to-use-epipenreg-auto-injector--epinephrine--anaphylaxis Allergic reactions vary in severity and can progress quickly to airway problems Epi-Pen: prescription from your doctor Epi-Pen if you are distant from help; may need to repeat; seek help immediately if you have used the Epi-PenAllergic reactions vary in severity and can progress quickly to airway problems Epi-Pen: prescription from your doctor Epi-Pen if you are distant from help; may need to repeat; seek help immediately if you have used the Epi-Pen

15. Diabetes Symptoms: polyuria, polydipsia, polyphagia (increased urine, thirst, eating) Problems: High blood sugar: dehydration, electrolyte imbalance warm, dry skin; rapid breathing; drowsy; fruity smell Low blood sugar: confusion, seizures sweaty, cool skin; jittery; rapid loss of consciousness if awake: 4 oz sugary drink or tablets if not awake: get emergency help If the person cannot manage his diabetes, seek medical attention. Management of diabetes has become more flexible and many more treatment options available People with diabetes have much more control about mgmt of their metabolism Biggest issue that they may need help with is low blood sugar- neurons die if not treated. 4 oz regular soft-drink is best treatment for low blood sugar; may also need protein if distant from next mealManagement of diabetes has become more flexible and many more treatment options available People with diabetes have much more control about mgmt of their metabolism Biggest issue that they may need help with is low blood sugar- neurons die if not treated. 4 oz regular soft-drink is best treatment for low blood sugar; may also need protein if distant from next meal

16. Nausea and vomiting Mal de mer Causes: Sensory: mal de mer, Meniere�s GI tract: gastritis, obstruction, poisoning Brain: tumor, concussion, migraine Metabolic: kidney, diabetes, other Misc: pregnancy, drugs, infections Problems: dehydration, electrolyte imbalance Care: �supportive� Anti-emetics (patch, pill, suppository), ginger Wrist bands �BRAT � diet (bananas, rice, applesauce, toast) Very common problem Treatment �supportive�- bring supplies Snowballs- dehydration brings on other problems Let the ill person choose what they want to try to eat or drink Consider less common problems if old-fashioned seasickness does not resolve ex., friend with �morning-seasickness�Very common problem Treatment �supportive�- bring supplies Snowballs- dehydration brings on other problems Let the ill person choose what they want to try to eat or drink Consider less common problems if old-fashioned seasickness does not resolve ex., friend with �morning-seasickness�

17. Heat-related illness-1 Cooling mechanism: vasodilation; sweating and evaporation Symptoms of HEAT EXHAUSTION: sweating, rapid pulse and breathing , muscle cramps, headache, nausea, dizziness, weakness, loss of appetite. Cause: excessive sweating, loss of fluids and electrolytes Signs of HEATSTROKE: skin red-hot and dry, shallow breathing with full and bounding pulse, confusion to sudden loss of consciousness, seizures, body temperature >104, vomiting, unable to drink, seizures; may follow heat exhaustion when sweating stops . Cause: failure of temperature regulation, loss of sweating Heat exhaustion (excessive sweating) vs Heatstroke (loss of sweating, medical emergency)Heat exhaustion (excessive sweating) vs Heatstroke (loss of sweating, medical emergency)

18. Heat-related illness-2 Care: Heat exhaustion: Lie down with legs raised. Sponge with cool water until temperature and behavior return to normal; encourage to drink. Possibly needs medical care, prepare for worsening. Heatstroke: Cool as rapidly as possible with water, not alcohol. Remove outer clothing, wrap in wet sheets until temperature is <100.4 under tongue or <99.5 under armpit. Do not give water or food if victim cannot swallow or respond or has had a seizure. Seek medical help immediately. Be prepared to give rescue breaths and chest compressions. Quickly identify if heatstroke symptoms are present Seek help immediately for temperature over 100.4 under tongue (99.5 under armpit) Excessive sweating: Cool sponging, cool liquids Skin flushed and dry: Cool wraps, no food or water, immediate medical helpQuickly identify if heatstroke symptoms are present Seek help immediately for temperature over 100.4 under tongue (99.5 under armpit) Excessive sweating: Cool sponging, cool liquids Skin flushed and dry: Cool wraps, no food or water, immediate medical help

19. Cold-related illness Heat conservation: vasoconstriction, less sweating, hair stands on end, shivering (increases metabolic needs 300%) Hypothermia: when body temp is <95 (can be fatal if <86) Causes: prolonged exposure, �wind-chill� factor, cold water, chronic illness, fatigue, inactivity, alcohol or drugs., extremes of age Symptoms: shivering, cold pale dry skin, apathy or disorientation, lethargy or loss of consciousness, slow shallow breaths, slow pulse. Care: Replace wet clothing; bathe in 100-104 degree bath if victim is fit and can navigate tub, otherwise use warm blankets or forced warm air. Do not use direct sources of heat. Handle gently because in severe cases, rushed movement may cause heart to stop. Seek medical attention for infants, the elderly, or if you have any doubts about victim�s condition. *They�re not dead until they�re warm and dead* Hypothermia if temp <95 (fatal b/o abnormal heart rhythms with temp <86) Warm slowly with warm blankets or forced warm air Handle gently (movement brings cold blood from extremities to torso and may worsen problems) Seek help for the very old or very youngHypothermia if temp <95 (fatal b/o abnormal heart rhythms with temp <86) Warm slowly with warm blankets or forced warm air Handle gently (movement brings cold blood from extremities to torso and may worsen problems) Seek help for the very old or very young

20. Fractures Symptoms: pain, limited movement, shortening or deformity of limb, swelling, bruising, coarse grating sound, possibly a wound or shock Care: prevent movement (esp if fracture is unstable) check circulation beyond injury, esp after dressing applied do not move victim until injury is splinted (unless in danger) support injured part with hands until immobilized materials to splint (apart or secured to unaffected body part) don�t straighten any bent body parts if open fracture, clean dressing with gentle pressure if bleeding apply ice to injured area for 20 minutes Biggest issues with fractures are pain and blood loss Pain caused by movement of fracture site Splint by securing to object or another body part Don�t straighten bent body parts Apply ice for 20 minutesBiggest issues with fractures are pain and blood loss Pain caused by movement of fracture site Splint by securing to object or another body part Don�t straighten bent body parts Apply ice for 20 minutes

21. Sprain/strain Cause: partially or completely torn or overstretched ligaments (sprain), muscles or tendons (strain); may be difficult to distinguish from fracture (may need x-ray) Symptoms: pain that worsens with movement or pressure, swelling, bruising Care: RICE x 24 hours rest: try not to move (may need splint or sling) ice: first 24 hours (20 min, 4-8x per day), then ice or heat compression: Ace bandage to reduce swelling and pain elevate: to decrease swelling Plus may need pain meds, an exercise program, or to see MD or PT Rest, ice, compression, elevation Hard to distinguish sprains and strains from fracturesRest, ice, compression, elevation Hard to distinguish sprains and strains from fractures

22. Head and neck injuries Cause: direct or indirect blows to head All head injuries are potentially serious Must recognize life-threatening brain compression deteriorating consciousness, difficulty breathing, unequal pupils clear fluid or watery blood from the nose or ear control external bleeding and have victim lie down other signs: dizzy, nausea, memory problems, headache Assume that anyone with a head injury also has a neck injury steady and support head, tell victim not to move support victim�s neck (don�t alter neck position if distorted) look for pain, tenderness, loss of movement or sensation Obtain medical attention ASAP, esp if victim is unconscious or has had brief period of unconsciousness with return to consciousness Anyone who has hit their head hard enough to become unconscious may have a neck injury If neck injury- avoid moving head (support and stabilize, don�t alter position) Types of head injuries: fracture, coup-contracoup, lacerate bridging veins SDH, middle meningeal artery Recognize serious head injury: losing consciousness, dizziness, memory loss, fluid from nose or ear Get help ASAP for serious head injuryAnyone who has hit their head hard enough to become unconscious may have a neck injury If neck injury- avoid moving head (support and stabilize, don�t alter position) Types of head injuries: fracture, coup-contracoup, lacerate bridging veins SDH, middle meningeal artery Recognize serious head injury: losing consciousness, dizziness, memory loss, fluid from nose or ear Get help ASAP for serious head injury

23. Bleeding Causes: various; arterial, venous; external, internal (blood that you can and can�t see); type of wound (abrasion, puncture, etc); wound location What to do: Assess the scene (safety), victim (stability, type of wounds, injuries) Comfort, reassure; use protective equipment (gloves, eye protection) Select dressing material (clean, large enough to cover wound) Control blood loss by direct pressure and elevation Reinforce (add more) dressing as needed (do not remove first piece) Assess for shock (rapid pulse, sweating, altered consciousness) Pressure points, tourniquet only if in extremis Obtain help if bleeding does not stop in 15 minutes, bleeding is heavy, or victim has trouble breathing. Various types of bleeding, obvious and hidden Most bleeding can be controlled with pressure and elevation Assess for shock: pulse becoming more rapid, sweating, altered consciousness (seek help) Tourniquet or pressure points only in extreme circumstancesVarious types of bleeding, obvious and hidden Most bleeding can be controlled with pressure and elevation Assess for shock: pulse becoming more rapid, sweating, altered consciousness (seek help) Tourniquet or pressure points only in extreme circumstances

24. Wounds Causes: various cuts, scrapes, punctures Care: Make sure scene is safe Use protective equipment (gloves, eyes) Wash with soap and water Stop bleeding with pressure (use fingers or palm of hand) Apply dressing to cover wound (consider antibiotic cream) Ask if victim has recent tetanus shot Call for help if excessive bleeding, shock (weak, dizzy, agitated or confused), or large or complex wound Make sure that scene is safe and that you are not in danger Wash with soap and water, apply dressing Consider antibiotic cream, tetanus shot, help if neededMake sure that scene is safe and that you are not in danger Wash with soap and water, apply dressing Consider antibiotic cream, tetanus shot, help if needed

25. Burns Causes: contact with heat, electricity, chemicals Symptoms: pain, difficulty breathing, shock (rapid pulse, shallow breathing, clammy skin, weak, dizzy, nausea, thirst, restless, possibly unconsciousness); may see red, blistered or broken skin Concerns: airway (esp if inhalation injury), dehydration, infection Care: stop the burning process apply cool liquid for 10 minutes (do not overcool) remove rings or constrictive items remove burned clothing if not stuck to skin cover burn with sterile or clean dressing (no lotions, oils) do not break blisters Transport to medical care ASAP if airway injury or large burn! Biggest problems: airway compromise (inhalation causes swelling) & fluid loss (weeping from large open surfaces) Obtain help for large burns, pain, shock, or special areas (hands, face, eyes, genitals) Cover with clean dressing, remove rings or constricting items Lightning- hidden wounds (burns) as current passes through bodyBiggest problems: airway compromise (inhalation causes swelling) & fluid loss (weeping from large open surfaces) Obtain help for large burns, pain, shock, or special areas (hands, face, eyes, genitals) Cover with clean dressing, remove rings or constricting items Lightning- hidden wounds (burns) as current passes through body

26. Snakes and spiders and varmints� Oh, my! Be familiar with native plants and animal species you�ll encounter along your itinerary, including how to identify them (and possibly capture the culprit for an expert to ID so you can get specific treatment for bites etc). Ex., jellyfish that can cause heart to stop in waters of northern Australia (3 minutes!) Reef-fish with neurotoxins Research the hazards in areas where you�ll be traveling!Ex., jellyfish that can cause heart to stop in waters of northern Australia (3 minutes!) Reef-fish with neurotoxins Research the hazards in areas where you�ll be traveling!

27. Snakebites-1 Be able to describe the snake (hard to ID; bring snake in if possible) cottonmouth- �raccoon mask� (white stripe on face) copperhead- splotchy apricot, burgundy, gray or tan rattlesnake- variable colors, patterns (diamond, stripes) & sizes coral snake- �red touches yellow, kill a fellow� stripes Signs of poisonous snakebite: progressive pain and swelling at bite nausea, vomiting, sweating, weakness Seek medical treatment ASAP unless snake positively ID'd as nonvenomous Most people do not like snakes; they eat bugs and are useful, but scary Appearance of snake may vary based on age, sex, geographic location For every really serious poisonous snake- there�s another snake that mimics it Bring in snake if possible Snake can bite even after head cut off Amount of toxin varies depending on degree of threat perceived by snake N/V, sweating, weakness, pain and swelling- seek helpMost people do not like snakes; they eat bugs and are useful, but scary Appearance of snake may vary based on age, sex, geographic location For every really serious poisonous snake- there�s another snake that mimics it Bring in snake if possible Snake can bite even after head cut off Amount of toxin varies depending on degree of threat perceived by snake N/V, sweating, weakness, pain and swelling- seek help

28. Snakebites-2 Care: (no cold, ice, suction, or cutting the site of bite) Keep victim calm, do not move body part that was bitten Gently wash bite with soap and water (leave uncovered) If coral snake: apply bandage with mild pressure over wound (no antivenom; this victim is treated with elective intubation and ventilation) Seek medical treatment ASAP unless snake positively ID�d as nonvenomous (need to get antivenom within 4-5 hours of bite) Coral snake (most in FL; a few in SE US): no anti-venom; elective intubation and ventilation Others- need anti-venom within 4-5 hr of bite Wash bite and leave uncovered, avoid movement and diffusion of toxin Avoid other injuries (caused by ice, suction, etc)Coral snake (most in FL; a few in SE US): no anti-venom; elective intubation and ventilation Others- need anti-venom within 4-5 hr of bite Wash bite and leave uncovered, avoid movement and diffusion of toxin Avoid other injuries (caused by ice, suction, etc)

29. Bites and stings: insects-1 Bees, wasps, hornets, yellow-jackets, fire-ants, mosquitoes, ticks Types of reactions: Immediate: Itching, stinging, swelling Delayed: Fever, hives, joint pain, swollen glands Infections (Lyme disease, Rocky Mtn Spotted Fever) Anaphylaxis: Nausea, facial swelling, difficulty breathing, abdominal pain, low blood pressure Immediate- allergy (can progress to anaphylaxis) vs delayed- inflammation or infection Anaphylaxis- life-threatening; Epi-Pen (may be useful to have aboard even if no prior history of severe reactions)Immediate- allergy (can progress to anaphylaxis) vs delayed- inflammation or infection Anaphylaxis- life-threatening; Epi-Pen (may be useful to have aboard even if no prior history of severe reactions)

30. Bites and stings: insects-2 Care: Mild (swelling, redness, and pain): scrape off stinger (do not pinch- or even touch), raise affected area if possible, apply ice pack consider hydrocortisone 0.5%, baking soda paste, or antihistamines Severe reaction (anaphylaxis): Epi-Pen, medical attention Stings to mouth and throat: suck on ice or cold water, consider transport to medical facility for airway problems Scrape off stinger (avoid injuring yourself) Soothing compresses Seek help if airway problemsScrape off stinger (avoid injuring yourself) Soothing compresses Seek help if airway problems

31. Bites and stings: spiders-1 20,000 spiders in North America 60 bite 4 venomous Black widow spider Brown recluse spider �Hobo� (aggressive) house spider Yellow sac spider Non-venomous spiders can bite (and be painful), too! 20K spiders, 60 bite, 4 venomous20K spiders, 60 bite, 4 venomous

32. Bites and stings: spiders-2 The 2 worst actors: Black widow: red hourglass or spots, occ yellow marks; prefers crevices; early symptoms: pain at bite, abdominal pain, muscle cramps, weakness, tremor (neurotoxic); mimics other illnesses; antivenom available. Brown recluse: violin pattern on upper body; prefers barns, basements, old tires; early symptoms: itching, nausea, vomiting; later skin necrosis (tissue death), abnormal clotting and bleeding, kidney damage; no antivenom. *hard to ID; bring spider if possible; get treated early Black widow: neurotoxic; there is an antivenom; �hourglass pattern� Brown recluse: no antivenom; abnormal clotting, bleeding, skin necrosis; �violin pattern�Black widow: neurotoxic; there is an antivenom; �hourglass pattern� Brown recluse: no antivenom; abnormal clotting, bleeding, skin necrosis; �violin pattern�

33. Bites and stings: spiders-3 �Hobo� spider: brown, mistaken for brown recluse; prefers; soil and debris, under rocks, in crawlspaces; pain, scabs, blisters, scars (often confused with brown recluse , less severe course). Yellow sac spider: pale yellow or white; prefers ceilings and foliage, often co-exists with people; symptoms mild redness, swelling, itching, heals in 2 weeks (mistaken for brown recluse). *hard to ID; bring spider if possible �Hobo� spider and Yellow-sac spider can be mistaken for brown recluse Bring spider in for ID Leave site alone Seek advice if identity unknown�Hobo� spider and Yellow-sac spider can be mistaken for brown recluse Bring spider in for ID Leave site alone Seek advice if identity unknown

34. Bites and stings: spiders-4 Non-venomous species: Raise body part if possible, apply ice packs or cool compresses Watch for signs of allergic reaction (wheezing) or anaphylaxis (collapse); seek medical attention as needed *hard to ID; bring spider if possible Watch for signs of allergic reactionWatch for signs of allergic reaction

35. Bites and stings: scorpions 2,000 species Cousin of the spider, usually only attacks if feels threatened More problem in developing countries (and Arizona) Check bedclothes, etc! Care: Wash with soap and water Cool compresses- on 10 minutes, off 10 minutes If possible, elevate bite area above heart Seek medical attention if blurred vision, wandering eye movements, muscle twitching, or numbness/tingling of extremities Scorpions (spider-like, land-based) NeurotoxinScorpions (spider-like, land-based) Neurotoxin

36. Bites and stings: marine life-1 Jellyfish, corals, anemones, Portuguese men-of-war, urchins, barracudas, eels, catfish Symptoms: Pain, bleeding, swelling, numbness, burning, redness More serious: cramps, diarrhea, difficulty breathing, fever, nausea/vomiting, paralysis, sweating, weak, faint dizzy; occasionally, anaphylaxis. May need help- removing stinger, or advanced medical care. Know what the marine life will be in the area where you are traveling Know which are poisonous May need help either removing stinger or advanced medical care (neurotoxins)Know what the marine life will be in the area where you are traveling Know which are poisonous May need help either removing stinger or advanced medical care (neurotoxins)

37. Bites and stings: marine life-2 Care: Wipe off stingers with towel; wear gloves. Wash with salt water, then soak in hot water 30-90 minutes if instructed by trained personnel. Possibly vinegar or meat tenderizer may neutralize toxins? Possibly compress limb above sting, immobilize limb? SEEK HELP- removing stinger, advanced medical care. Wipe off stingers Neutralize with salt water Here�s when you�d need a subscription medical service to call for advice! Possibly apply vinegar or meat tenderizer Possibly immobilize limbWipe off stingers Neutralize with salt water Here�s when you�d need a subscription medical service to call for advice! Possibly apply vinegar or meat tenderizer Possibly immobilize limb

38. Rhus plants: Poison oak/ivy/sumac-1�leaves of three, let them be� Most common allergic contact dermatitis in the US 60-80% of people react to this allergen ( is both irritant and allergen) Urushiol (an oil) found in poison oak/ivy/sumac in roots/stem/fruit Exposure by direct contact, smoke, your clothes (for years!) IvyBlock can be applied before plant contact TechNu removes urushiol, then alcohol dissolves unabsorbed poison Dry clean your clothes or wash separately and clean machine or leave clothes in sun (UV breaks down urushiol) The cousins: Poison oak/ivy/sumac Oil is very resistant to dispersal- lasts for years in clothes despite washingThe cousins: Poison oak/ivy/sumac Oil is very resistant to dispersal- lasts for years in clothes despite washing

39. Rhus plants: Poison oak/ivy/sumac-2 Symptoms: Itching, then redness, then rash (4 hours to 10 days later; can last 3 weeks), then fluid-filled blisters (non-contagious) 15% severely allergic, some with respiratory problems (esp if plants burned and inhaled urushiol) Care: cleanse yourself with alcohol, magnesium sulfate, or TechNu avoid soaps (may move the urushiol to other areas!) clean your clothes and equipment with alcohol cool compresses or over-the-counter soothing gels topical steroid or non-steroidal anti-inflammatory creams oral anti-histamines or steroids Symptomatic relief Avoid soaps (spreads the active ingredient)Symptomatic relief Avoid soaps (spreads the active ingredient)

40. Summary Understand your plans and potential circumstances Know your skills and bring supplies for what you can treat Ask your physician about necessary medications and supplies Consider First Aid/CPR courses (Red Cross, Heart Association) Consider First Aid books (American College of Emergency Physicians) Consider evacuation insurance (Divers� Alert Network) Consider subscription medical advice service (see Internet Resources, next slide) HAVE FUN! Plan ahead Consider coursework and books as well as bringing medications and supplies specific to where you are traveling Consider subscription medical service or evacuation insurance for distant travel HAVE FUN!Plan ahead Consider coursework and books as well as bringing medications and supplies specific to where you are traveling Consider subscription medical service or evacuation insurance for distant travel HAVE FUN!

41. Internet Resources(*not* endorsements) Medical kits, subscription medical services http://www.riparia.org/cruising_medical_kit.html http://www.marmed.com/marmed.htm http://www.seasidemarineintldrug.com/home.html https://www.tripprep.com/scripts/main/default.asp http://www.worldclinic.com/ Evacuation insurance http://www.diversalertnetwork.org/insurance/ http://www.diversalertnetwork.org/ Subscription medical services First aid kits Evacuation insuranceSubscription medical services First aid kits Evacuation insurance