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Medical Information

When you want, or need, to know more than the superficial, such as when you are

where there is no access to a physician.

Prototypically: Medicine at Sea

Comments/Disclaimer

This medical information is provided for education purposes only. I am making no attempt to practice medicine over the internet. This is being written to give some basic knowledge for those that are physically isolated from access to professional medical care, such as sailors at sea. This is to help in deciding whether an emergent medical condition exists, how to initially deal with it, and whether evacuation is needed. It is by no means exhaustive or meant to replace personal medical attention. Please do not contact me regarding your personal condition. Over the years I have received many emails from people asking for help with their personal chest pain, or whatever. Sometimes they write during acute pain. This is ridiculous. You can't practice medicine over the internet. If I find their email, after it has been filtered by my spam filter, it may be days or weeks later. My response, if any, will be to contact their regular provider. Even a bad doctor in person is better than an email. Please use this information in the spirit in which it is intended.

Sincerely, Mark R. Anderson, M.D.

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First Aid ot Sea

Thirteen Key Points and Reduction of Dislocated Fingers and Shoulders

v. 1.2 (Dec. 16, 2004)

Cruising Medical Kit

1) All bleeding stops... Eventually!

Use direct pressure. You may need to apply it for 15 min. or more without interruption. Even severe arterial bleeding can be stopped with continuous direct pressure.

2) Any wound, ANY WOUND, will heal eventually even if you do nothing to it, assuming you don't bleed to death first or die of gangrene. IOW, don't feel that you have to suture if you don't know what you're doing..

3) Abscesses must be drained to heal. Use heat to bring them to a head over a couple days. Lance when there's a soft thin spot telling you were to go.

4) 90% of everything gets better on its own!

5) It wasn't until about 1900 that the average patient could go to the average doctor and stand a better than 50/50 experience of benefiting by the experience.

6) Don't eat reef fish high on the food chain. They may give you Ciguatera poisoning.

7) Don't eat clams dug (Northern hemisphere) in months without 'R's. That's roughly the red tide months. Of course it could be safe, but be careful unless you're in an area where clams are monitored and digging sites posted as needed. You risk Paralytic Shellfish Poisoning

8) Have ice for injuries, or at least those instant chemical icebags.

9) Know how to reduce dislocated fingers and shoulders. These are the most commonly dislocated joints.

Fingers: The finger past the involved joint, (at the base of the finger or at its first joint) is displaced to the top of the hand. I.e. it takes an obvious step up at that point. (I sure hope this makes sense to differentiate it from the different typical deformities of finger fractures.)

If done quickly and confidently, no anesthesia is usually needed. Grab the injured hand with one of your hands. Grab the finger past the deformity with you other hand. Now, with one action, pull the finger away from the hand, bend it up, (increasing the deformity) 10-20 degrees or so to release the base of the joint and then swing the finger down over the joint back into its normal position. (Occasionally it's not this easy and the rare one needs surgery to reduce because stuff is caught in the joint.) After reduction, put gauze between that finger and it's neighbor, (longer finger) and buddy tape the two fingers together.

Shoulder: It got dislocated usually by falling on your outstretched arm behind you, or something caught it and threw it over your head and back to far. Somehow the arm is almost always gotten back to something close to normal position by the time I see them. But... the shoulder hurts, you don't want to/can't move it, AND.... the contour of the shoulder joint over the deltoid is flattened. In fact you can feel a hollow under the tip of the shoulder, (actually under the tip of the scapular that forms the roof of the shoulder joint.) If you don't see the flattening and feel the hollow, you may be dealing with a fracture instead of a dislocation, in which case sling the arm and strap the upper arm to the chest and leave it there. You may feel the head of the humerus in front of the shoulder or under the collar bone.

There are many ways to reduce a shoulder. Two seem reasonably applicable to life at sea. The sooner it's reduced the easier it will be. If you don't do it immediately, it'd help alot to give the victim the strongest pain reliever you've got, plus a stiff swig of rum, and wait an hour or so.

Method #1:

Have the victim lay face up on the cabin sole. Stretch out the injured arm straight up. Attach a short line with a larks head (cow hitch) to the wrist. Attach that line to a block and tackle and secure the tackle to the cabin overhead, e.g. to a handhold. Haul on the tackle until the victim starts to lift off the sole. Secure there. Wait!... The point is to use gravity to fatique the victim's shoulder muscles. Sometime, perhaps 20-30 minutes later the shoulder may pop back in place. If it doesn't by then, pull sideways on the upper arm away from the torso.

Method #2:

This is faster but more complex. If done slowly, no anesthesia may be needed and it can be done with little or no setup. You may feel the shoulder pop in at any step in this. Then there's no need to go further but bring the arm back to normal position and sling and strap the arm there. Whenever you reach much resistance and intolerable pain, you have to pause and try to get the victim to relax before proceeding. In the ER this is much easier because we can use golden hammers, er, I mean, strong drugs.

Lay the victim face up on a berth/settee with the injured arm toward the aisle. Bend the elbow 90 degrees, pointing the forearm straight up. Apply horizontal pressure on the elbow until you get the elbow right against the side of the torso. Hold it there. Now slowly rotate the upper arm about its axis by swinging the hand/forearm out to the side. You'll encounter resistance and pain. Pause a few moments. Encourage deep breathing (on the part of the victim) and relaxation, (both of you). Proceed. Continue until the forearm is pointed directly horizontal, i.e. to the side of the victim. The elbow has been kept beside the torso. No pop? Continue. Slowly move the arm and bent elbow horizontally as a unit, pivoting at the shoulder until the upper arm points out 90 degrees from the body and the forearm straight overhead, (w/ respect to the victim, in fact it's still horizontal.) Pause for relaxation as needed. No pop? Continue... [Now it'd be nice if you'd had the foresight to wrap a sheet around the victim's torso and tie it to the back of the settee so the victim isn't pulled off the berth/settee. What could also work well is to have started with the lee cloth between arm and torso and extending to the armpit. The body would be right against the lee cloth and now it comes into play.] So, the upper arm is pointing horizontal away for the body and the forearm to the patient's overhead, (like he's waving). Now, pull steady and strong directly along the upper arm horizontally, (hook your elbow in the crook of his). You're trying to pull directly away from the body. Put your weight into it. No pop? Have another crew member push moderately on the upper arm at the armpit, horizontally so as to 'lift' the head of the humerus back into its socket while you're still pulling out to the side. Hopefully the shoulder has been reduced by now, even if you didn't actually feel it pop in. The only thing left to do is swing the arm back in front of the body into the sling position. There shouldn't be any resistance now. Sling and strap.

No luck??? Start over before or after giving strong pain killers, and another swig of rum.

10) Know CPR, but be sure it's needed before you do it.

11) Know the Heimlich, but be sure it's needed before you do it. Don't do it if the victim can speak.

12) Know how to use the radio. Then you can get in touch with expert advice.

13) Have an adequate medical kit so you can use that advice.

Email: capn-shanghai@comcast.net

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