Thursday, November 1, 2012

CPR , AMBU BAG AND OXYGEN RESUSCITATION ON CHEMICAL TANKERS- CAPT AJIT VADAKAYIL


MEDICAL EMERGENCIES,  CPR , AMBU BAG AND OXYGEN RESUSCITATION- CAPT AJIT VADAKAYIL


                 
CPR

CPR can be a one man job.  

15 external heart compressions at 19 times per minute and 2 blows.  If the patient has a regular heart beat , don’t give heart compressions.  And if he is breathing there is no need to blow.  


Only a proportion of the air exhaled is carbon dioxide there is plenty of Oxygen there to do what is required under normal circumstances. People don't use all of the oxygen they breath in, a % of it is blown right back out of the body again. 

SO WHEN YOU DO CPR,  DONT CONSUME ALL THE OXYGEN YOURSELF, BY HOLDING YOUR BREATH IN YOUR OWN LUNGS , BEFORE BLOWING OUT.


Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.  CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration.


CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage. 


Advanced life support and defibrillation, the administration of an electric shock to the heart, is usually needed for the heart to restart, CPR is generally continued, until the patient regains a heart beat (called "return of spontaneous circulation" or "ROSC") or is declared dead


When cardiac arrest occurs, the heart stops pumping blood.  CPR can support a small amount of blood flow to the heart and brain to “buy time” until normal heart function is restored.

Cardiac arrest is often caused by an abnormal heart rhythm called ventricular fibrillation (VF).  When VF develops, the heart quivers and doesn't pump blood. The victim in VF cardiac arrest needs CPR and delivery of a shock to the heart, called defibrillation.  Defibrillation eliminates the abnormal VF heart rhythm and allows the normal rhythm to resume. 


AMBU BAG

A bag valve mask (also known as a BVM or Ambu bag) is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately.


The device is self-filling with air, although additional oxygen (O2) can be added. manually provide mechanical ventilation in preference to mouth-to-mouth resuscitation.  The BVM consists of a flexible air chamber, about the size of a rugby ball, attached to a face mask via a shutter valve. 

When the air chamber or "bag" is squeezed, the device forces air through into the patient's lungs; when the bag is released, it self-inflates, drawing in ambient air or a low pressure oxygen flow supplied from a regulated cylinder, whilst the patient's lungs deflate to the air through the one way valve.


Squeezing the bag once every 5 seconds for an adult or once every 3 seconds for an infant or child provides an adequate respiratory rate (12 respirations per minute in an adult and 20 per minute in a child or infant).
Ensure that the mask portion of the BVM is properly sealed around the patient's face (that is, to ensure proper "mask seal"); otherwise, air escapes from the mask and is not pushed into the lungs. 

In order to maintain this protocol, some protocols use a method of ventilation involving two rescuers: one rescuer to hold the mask to the patient's face with both hands and ensure a mask seal, while the other squeezes the bag.

When using a BVM, as with other methods of positive pressure ventilation, there is a risk of over-inflating the lungs. This can lead to pressure damage to the lungs themselves, and can also cause air to enter the stomach, causing gastric distention which can make it more difficult to inflate the lungs and which can cause the patient to vomit. This can be avoided by care on behalf of the rescuer.


OXYGEN RESUSCITATOR

Every chemical tanker crew member must know how to use the portable oxygen resuscitator with 2 litre compressed oxygen cylinder.  

Regular drills  must be  held on board. Show the effect on human lungs by attaching the bellow, where oxygen fills the balloon and at a set pressure of the relief valve , how it automatically releases the contents and repeats the breathing cycle.The operating manual must remain in the kit. 


The airbottle must always contain the required minimum pressure of 150 bars OR in the green zone , or 30 minutes for  an adult. The 2 litre bottle can be filled up , by equalizing with a large high pressure, accumulator bottle, till the pressure guage does not move anymore.

Making sure that there is no mucous or froth in the nose and mouth, caused by chemical  allergy , pulmonary odema . If it is indeed there an aspirator (connected to a catheter) , powered by the compressed oxygen can be used to suck it out. Insert the catheter into the nose and mouth and press the aspirator button in short pushes.  You can see the sucked out contents in the plastic delivery bottle.


Once the mucous is cleared, place the face mask firmly to cover the nose and mouth. Automatic resuscitation of positive (+14mm ) and negative pressure ( -8mm ) will start. There is a volume setting for adult/ child and to increase the delivery volume . There is as air-oxygen mixing lever, to bring down the oxygen delivered from 100% , 0.5 LTM to lower values of 21%,  6 LTM gradually as the patient recovers .

Long-term exposure to 100% oxygen is toxic.  Several brain areas responded to 100 percent oxygen by kicking the hypothalamus into overdrive, The hypothalamus overreacted by dumping a massive flood of hormones and neurotransmitters into the bloodstream. These chemicals interfere with the heart's ability to pump blood and deliver oxygen - the opposite effect you want when you're trying to resuscitate someone.

To suspend oxygen resuscitation, the screw knob of the hose adaptor can be loosened . there is an extension tube upto 4 meters long from the cylinder to face mask.

A humidifier operated by fresh water can be screwed onto the flow meter, which has  a white floating ball inside..

MEDICAL EMERGENCIES
No.
Action
Tick
1
Master informed
2
Name and rank of sick/injured crew-member
3
Nature of illness or cause of injury
4
Read MSDS sheets of cargo carried, Ems, MFAG if illness due 
to vapour exposure
5
Contact shore stations or ships with doctor on board for 
assistance using URGENCY GMDSS alert
6
Check for allergy
7
Date of last administration of medicine/ antidote and type
8
Specific assistance required
9
Prepare deviation statement if necessary
10
Inform the Company
11
If injury due to defective equipment keep part on board for 
inspection
12
Witnesses statements
13
Proper Illness / injury form to be completed
14
Prepare account of wages
15
Prepare personal effect inventory with witness
16
Enter facts in medical log and deck log book

Note:

Master must not hesitate to seek radio medical assistance for chemical poisoning and injury cases. If proper treatment is given in good time recovery will be faster.

Never give Morphine to a person who has been gassed  especially by irritant gases.. For all poisoning you can give a glass of milk. Milk should NOT be given for degreasing solvents and Chlorinated Hydrocarbon poisoning.

Carbon Monoxide poisoning makes the lips bright red and the face pink. Toxic and noxious gases have distinctive odours except Carbon Monoxide. CO causes chemical asphyxiation by restricting O2 in blood. TLV/ 25ppm

Pulmonary odema:  Fluid collects in lungs and you have difficulty in breathing or lying flat. Caused by inhalation of certain gases or by vomited matter going into lungs. It can be delayed by as much as 2 days.  Use a Guedel airway which can vacuum out froth from the airway. If the patient is conscious he must be kept in a sitting up position and if unconscious kept in the three prone position. The medicine used is Furosemide.

Anaphylaxis is allergy and swelling of tissue which can be fatal.

H2S gas has odour threshold  of less than 1 ppm. Rapid paralyses sense of smell. TLV/ 10 ppm. Heavier than air, eyes get sensitive to light.  Metallic taste in mouth, head ache , vomiting , diarrhoea, paralysis , difficult breathing.

TDI and Nitriles enters blood and paralyses the nervous system and causes death.




CAPT AJIT VADAKAYIL
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6 comments:

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  4. Dear Sir, Thank you so much for being such a powerful beacon at the front of professional and non-professional virtues of my life. Your ideas,thoughts,knowledge are food for thoughts. I think you must be definitely some form of incarnation of great soul from history, as a body perishes and not his soul and virtues.

    Sir, I always had a question.Why can't we have a Defibrillator on board all ships as mandatory medical instrument. Now a days even shopping malls also have them, lest our ships..Its so sad that POWER HOUSES/AUTHORITIES/COMPANIES fail to recognize the need. I thought there must be a reason for not having it. Can you put some light on it?

    ReplyDelete
    Replies
    1. hi sk,

      Defibrillation is a process in which an electronic device gives an electric shock to the heart.
      This helps reestablish normal contraction rhythms in a heart having dangerous arrhythmia or in cardiac arrest. We have small portable defibrillators called automated external defibrillators or AEDs.

      The procedure involves the delivery of an electric shock to the heart which causes depolarisation of the heart muscles and re-establishes normal conduction of the heart’s electrical impulse.

      In the hands of a monkey this instrument can KILL.

      On ships we have a pre-medical test.

      For accidents we are trained to do CRP.

      CRP is very effective . Till today I have revived 8 people who did NOT have pulse or breath.

      http://ajitvadakayil.blogspot.in/2015/04/heart-matters-capt-ajit-vadakayil.html

      Germany is the first flag state worldwide that legally requires to carry AEDs on seagoing merchant vessels.

      It is a boon on cruise ships were old people with one leg in the grave sails for a last HURRAH.

      If your heart stops beating properly and blood stops flowing, your brain starts to lose its oxygen supply and you can die within five minutes. CPR (cardiopulmonary resuscitation) can help maintain the flow of oxygen to the brain, but getting the heart restarted and working normally often requires defibrillation with an electric shock.

      As the name suggests, defibrillation stops fibrillation, the useless trembling that a person's heart muscles can adopt during a cardiac arrest. Simply speaking, a defibrillator works by using a high-voltage (something like 200–1000 volts) to pass an electric current through the heart so it's shocked into working normally again.

      The patient's heart receives roughly 300 joules of electrical energy (about as much as a 100 watt incandescent lamp uses in three seconds).

      I WOULD RECOMMEND A DEFIBRILLATOR ON INDIAN CHEMICAL TANKERS. PROVIDE TRAINING AND TRAINING VIDEOS .

      Capt ajit vadakayil
      ..

      Delete
  5. Dear Ajit Paaji,

    For once,can I hug you?

    Jai Hind!
    dkb

    ReplyDelete