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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