mcga-shs_capt_guide_chap7.pdf

127

CHAPTER 7

CARDIOVASCULAR

SYSTEM –

HEART AND BLOOD

VESSELS

Chest (heart) pain

High blood pressure –

hypertension

Varicose veins

GENITO-URINARY

SYSTEM

Paraphimosis

Testicular pain

Urinary problems

GENERALISED

ILLNESSES

Alcohol abuse

Allergy

Anaemia

Colds

Diabetes

Drug abuse

Hayfever

High temperature

Lymphatic

inflammation

Oedema

Sea sickness

BRAIN AND NERVOUS

SYSTEM

Mental illness

Neuralgia

Paralysis

Strokes

RESPIRATORY

SYSTEM – CHEST AND

BREATHING

Asthma

Bronchitis

Chest pain

Pleurisy

Pleurodynia

Pneumonia – lobar

pneumonia

Pneumothorax

HEAD AND NECK

Ears

Eyes

Headache

Sinusitis

Teeth and gums

Throat

ABDOMINAL SYSTEM –

GASTRO-INTESTINAL

TRACT

Abdominal pain

Anal fissure

Anal itching (anal

pruritus)

Appendicitis

Biliary colic (gallstone

colic)

Cholecystitis

(inflammation of the

gall bladder)

Diarrhoea

Haemorrhoids (piles)

Hernia (rupture)

Intestinal colic

Jaundice

Peritonitis

Ulcers (peptic

ulceration)

Worms

LOCOMOTOR SYSTEM –

MUSCLES AND BONES

Backache

Gout – gouty arthritis

Rheumatism

SKIN AND SUPERFICIAL

TISSUES

Bites and stings

Boils, abscesses and

carbuncles

Cellulitis

Hand infections

Skin disease

128

THE SHIP CAPTAIN’S MEDICAL GUIDE

CARDIOVASCULAR SYSTEM – HEART AND BLOOD VESSELS

Chest (Heart) pain

With any suspected heart pain get RADIO MEDICAL ADVICE .

When the calibre of the coronary arteries becomes narrowed by degenerative change,

insufficient blood is supplied to the heart and, consequently, it works less efficiently. The heart

may then be unable to meet demands for extra work beyond a certain level and whenever that

level is exceeded, attacks of heart pain (angina) occur. This can be compared to a ‘stitch’ of the

heart muscle. Between episodes of angina the patient may feel well.

Any diseased coronary artery is liable to get blocked by a blood clot. If that blockage occurs

the blood supply to a localised part of the heart muscle is shut off and a heart attack (coronary

thrombosis) occurs.

Angina (Angina Pectoris )

Angina usually affects those of middle age and upward. The pain varies from patient to patient

in frequency of occurrence, type and severity. It is most often brought on by physical exertion

(angina of effort) although strong emotion, a large meal or cold conditions may be additional

factors. The pain appears suddenly and it reaches maximum intensity rapidly before ending

after two or three minutes. During an attack the sufferer has an anxious expression, pale or grey

face and may break out in a cold sweat. He is immobile and will never walk about. Bending

forward with a hand pressed to the chest is a frequent posture. Breathing is constrained by pain

but there is no true shortness of breath.

During the attack the patient will describe a crushing or constricting pain or sensation felt

behind the breast bone. The sensation may feel as if the chest were compressed in a vice and it

may spread to the throat, to the lower jaw, down the inside of one or both arms – usually the

left – and maybe downwards to the upper part of the abdomen.

Once the disease is established attacks usually occur with gradually increasing frequency and

severity.

General treatment

During an attack the patient should remain in whatever position he finds most comfortable.

Afterwards he should rest. He should take light meals and avoid alcohol, tobacco and exposure

to cold. He should limit physical exertion and attempt to maintain a calm state of mind.

Specific treatment

Pain can be relieved by sucking (not swallowing) a tablet of glyceryl trinitrate 0.5 mg or using

the metered dose spray. The tablet should be allowed to dissolve slowly or the spray directed

under the tongue. These tablets can be used as often as necessary and are best taken when the

patient gets any symptoms indicating a possible attack of angina. Tell the patient to remove any

piece of the tablet which may be left when the pain has subsided since glyceryl trinitrate can

cause a throbbing headache. The glyceryl trinitrate 0.5 mg may also be taken before any activity

which is known to induce an angina attack.

If the patient is emotional or tense and anxious, give him diazepam 5 mg three times daily

during waking hours, and if sleepless 10 mg at bed time. The patient should continue to rest

and take the above drugs as needed until he sees a doctor at the next port.

WARNING: Sometimes angina appears abruptly and without exertion or emotion even when

the person is resting. This form of angina is often due to a threatened or very small coronary

thrombosis (see below), and should be treated as such, as should any attack of anginal pain

lasting for longer than 10 minutes.

Coronary thrombosis (myocardial infarction)

A heart attack happens suddenly and while the patient is at rest more frequently than during

activity. The four main features are pain of similar distribution to that in angina, shortness

of breath, vomiting and degree of collapse which may be severe. The pain varies in degree

Chapter 7 OTHER DISEASES AND MEDICAL PROBLEMS

129

from mild to agonising but it is usually severe. The patient is often very restless and tries

unsuccessfully to find a position which might ease the pain. Shortness of breath may be severe

and the skin is often grey with a blue tinge, cold and covered in sweat. Vomiting is common in

the early stage and may increase the state of collapse.

In mild attacks the only symptom may be a continuing anginal type of pain with perhaps

slight nausea. It is not unusual for the patient to believe mistakenly that he is suffering from a

sudden attack of severe indigestion.

General treatment

The patient must rest at once, preferably in bed, in whatever position is most comfortable until

he can be taken to hospital. Exertion of any kind must be forbidden and the nursing attention

for complete bed rest carried out. Restlessness is often a prominent feature which is usually

manageable if adequate pain relief is given. Most patients prefer to lie back propped up by

pillows but some prefer to lean forward in a sitting position to assist breathing. A temperature,

pulse and respiration chart should be kept at 1 / 2 hourly intervals. Smoking and alcohol should be

forbidden.

Specific treatment

If available, give one Aspirin tablet (150–300mg) by mouth. Oxygen should be given, in as high

a flow rate as possible. Whatever the severity of the attack it is best to give all cases an initial

dose of morphine 10 – 15 mg and an anti-emetic at once. In a mild attack it may then be possible

to control pain by giving codeine 60 mg every 4 to 6 hours. If the patient is anxious or tense, in

addition give diazepam 5 mg three times a day until he can be placed under medical

supervision. In serious or moderate attacks, give morphine 15 mg with an anti-emetic three to

four hours after the initial injection. The injection may be repeated every four to six hours as

required to obtain pain relief. Get RADIO MEDICAL ADVICE .

Specific problems in heart attacks

If the pulse rate is less than 60 per minute get RADIO MEDICAL ADVICE .

If the heart stops beating get the patient onto a hard flat surface and give chest compression

and artificial respiration at once.

If there is obvious breathlessness the patient should sit up. If this problem is associated with

noisy, wet breathing and coughing give frusemide 40 mg intramuscularly, restrict the fluids,

start a fluid balance chart and get RADIO MEDICAL ADVICE .

Paroxysmal tachycardia

This is a condition which comes in bouts (paroxysms) during which the heart beats very rapidly.

The patient will complain of a palpitating, or fluttering or pounding feeling in the chest or

throat. He may look pale and anxious and he may feel sick, light-headed or faint. The attack

starts suddenly and passes off after several minutes or several hours just as suddenly. If the

attack lasts for a few hours the patient may pass large amounts of urine. The pulse will be

difficult to feel because of the palpitations, so listen over the left side of the chest between the

nipple and the breast bone and count the heart rate in this way. The rate may reach 160 – 180

beats or more per minute.

General treatment

The patient should rest in the position he finds most comfortable. Reassure him that the attack

will pass off. Sometimes an attack will pass off if he takes and holds a few very deep breaths or

if he makes a few deep grunting exhalations. If this fails, give him a glass of ice cold water to

drink.

Specific treatment

If these measures do not stop an attack, give diazepam 5 mg. Check the heart rate every quarter

of an hour. If the attack is continuing get RADIO MEDICAL ADVICE .

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THE SHIP CAPTAIN’S MEDICAL GUIDE

Chest pain – associated signs

Diagram

number

Position and type

of pain

Age group

Onset

Breathless

General

condition

Blue lips

and ears

Pale colour

Behind breast bone

– down left arm,

up into jaw or down

into abdomen.

Constricting.

Middle age

and upward

Sudden,

usually after

effort

Looks ill

and anxious

Yes

Behind breast bone,

up into jaw, down

into abdomen.

Down either arm,

usually left.

Crushing.

Middle age

and

upward.

Can occur

in younger

people

Sudden

often

at rest

Yes (severe)

Looks

very ill.

Collapsed.

Restless.

Vomiting

Often

Yes

Burning sensation

up behind the whole

of breast bone.

Any

May follow

mild

indigestion

Good. May

vomit

Not usually

Along line of ribs on

one side.

Aching.

Any but

more likely

in older

people

Slow

Good

Any part of rib cage.

Sharp stabbing.

Worse on breathing

and coughing.

Any part of rib cage.

Sharp stabbing.

Worse on breathing

and coughing.

Any

Sudden

Slight

Good

Any

Gradual

or sudden.

Often

follows

a cold

Slow

Yes

Looks

very ill.

Flushed

Yes

Pain passes from

right abdomen

through to shoulder

blade and to tip of

right shoulder.

Same distribution

as for cholecystitis.

Agonising colicky

pain.

Usually

middle aged

Ill,

sometimes

flushed.

Vomiting

Not

normally

Any, often

middle aged

Sudden

Yes when

spasms are

present

Ill, restless.

Nausea and

vomiting

Yes

Any part of rib cage.

Sharp pain.

Any

Sudden

Yes

Good at first

Later

Yes

At site of injury.

Sharp stabbing

made worse by

breathing.

Any

Sudden

Normally

good, but

may be

shocked

Yes (when

shocked)

Any part,

often in back.

Dull aching.

Any part of rib cage.

Continuous ache

made worse by

breathing.

Any

Slow

Good

Any

Sudden

Good

Chapter 7 OTHER DISEASES AND MEDICAL PROBLEMS

131

Sweating

Temperature

Pulse

rate/min

Respiration

rate/min

Tenderness

Additional information

PROBABLE

CAUSE OF PAIN

Yes

Normal

Nil

Can be brought on by effort, eating

a large meal, and by cold or strong

emotion. Passes off in two to three

minutes on resting. Patient does not

speak during an attack.

Angina

page 128)

Yes

Normal

Raised

60–120

Increased

24+

Nil

Pulse may be irregular – heart may

stop.

Coronary

Thrombosis

(page 128)

Normal

Nil

Patient may notice acid in mouth.

Heartburn (see

Peptic ulcer)

(page 150)

Usually

normal

Normal

Often

between

ribs in

affected

segment

Small spots similar to those of

chickenpox appear along affected

segment. Breathing will be painful.

May affect other parts of the body.

Shingles

(page 178)

Elevated

37.8°C –

39.4°C

(100–103°F)

Elevated

39.4°C –

40.6°C

(103–105°F)

Raised

100–120

Increased

Nil

May be the first sign of pneumonia.

Pleurisy

(page 135)

Yes

Raised

110–130

Greatly

increased

30–50

Nil

Dry persistent cough at first,

then sputum becomes ‘rusty’.

Pneumonia

(page 136)

Elevated up

to 30°C

(101°F)

Raised to

110

Slightly

increased

Over gall

bladder

area

Note that pain in the right shoulder

tip may result from other abdominal

conditions causing irritation of the

diaphragm.

Cholecystitis

(page 145)

Yes

Usually

normal

Raised

72–110

Increased up

to 24 or

more during

spasms

Over gall

bladder

area

Biliary colic

(page 145)

Normal

Raised

72–100

Increased

18–30

Nil

May be caused by penetrating

wound of chest or occur

spontaneously. Symptoms and signs

depend on the amount of air in

the pleural cavity. The affected side

moves less than the normal side.

Pneumothorax

(page 137)

Only if

shocked

Normal

Raised if

shocked

Increased

At affected

area

Fractured ribs may penetrate lung.

Look for bright red frothy sputum

and pneumothorax.

Fracture of the

rib (page 38)

Normal

At affected

areas

‘Nodules’ may be felt. Common site

around the upper part of the back.

Muscular

rheumatism

(page 169)

Pleurodynia

(page 136)

Normal

At affected

areas

Do not confuse with pleurisy.

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