Brown recluse

Personalizing your approach to medical emergencies
and more minor medical problems
Kathie King MD
FHYC Fleet Surgeon
October 15, 2010
Learn new skills
Validate what you already know
(this is a sophisticated crowd)
(remind you of easily-forgotten facts)
(Caveat: this is not a first aid course)
What is First Aid?
Medical Emergencies
 First response to situation
that requires advanced care
Life or Limb-threatening
Cardiac Arrest
Allergic reactions
Broken bones
Non-emergency First Aid
 Minor medical needs
 May need advanced care
 Minor wounds
 Minor allergies
 Common medical problems
treated with over-the-counter
 Common injuries
“The first thing about
First Aid is to be careful,
so First Aid can be
 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
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?
… from land to a marine environment
Your knowledge about your medical conditions
Your knowledge about general medical conditions and First Aid
Subscription medical services
Evacuation insurance (Divers Alert Network)
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)
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!
Common Medical Problems
 Heart Attack
 Fractures
 Stroke
 Wounds
 Seizure
 Bleeding
 Allergic Reaction
 Head/neck injury
 Diabetes
 Sprain/strain
 Nausea/Vomiting
 Burns
 Heat-related illness
 Snakebites
 Cold-related illness
 Bites and stings
 Poison oak/ivy/sumac
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
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)
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
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:
Symptoms: polyuria, polydipsia, polyphagia
(increased urine, thirst, eating)
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.
Mal de mer
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)
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: 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
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.
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*
Symptoms: pain, limited movement, shortening or deformity of limb,
swelling, bruising, coarse grating sound, possibly a wound or shock
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
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,
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
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
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.
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
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!
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).
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
(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)
Bees, wasps, hornets, yellow-jackets, fire-ants, mosquitoes, ticks
Types of reactions:
Immediate: Itching, stinging, swelling
Fever, hives, joint pain, swollen glands
Infections (Lyme disease, Rocky Mtn Spotted Fever)
Anaphylaxis: Nausea, facial swelling, difficulty breathing,
abdominal pain, low blood pressure
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
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
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!
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
“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
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
2,000 species
Cousin of the spider, usually only attacks if feels threatened
More problem in developing countries (and Arizona)
Check bedclothes, etc!
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
Jellyfish, corals, anemones, Portuguese men-of-war, urchins,
barracudas, eels, catfish
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.
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.
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)
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)
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
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)
Medical kits, subscription medical services
Evacuation insurance