SGYC Marine Medical Information
Dr. Mark Monroe has been appointed the SGYC Fleet Surgeon. In that capacity, he will present medical information germane to yachting and SGYC issues. This information will be presented in brief articles with an index at the top of the page. It would be prudent for all members to review these articles to assure they are aware of medical issues related to all boaters.
Index of Marine Medical Information
SGYC Magnetic Name Badge Medical Alert
by Mark N. Monroe, M.D.
Be advised that our new “Magnetic Name Tags” should not be worn by any person with a pacemaker. If you have had a pacemaker inserted and also have a SeaGate Yacht Club name badge with a magnet, please discontinue its use immediately! Please contact our Membership Chair, Joanne McCormick, E-mail: jobobmc2@verizon.net or (714) 840-0136 in order to obtain a replacement badge with a pin closure.
Total Knee Replacement
by Mark N. Monroe, M.D.
Since I am one of several members of SGYC to receive a total knee replacement, I thought it would be appropriate to discuss indications, benefits, alternatives and possible risks and benefits of this procedure. When the knee is so severely damaged by injury or arthritis to the point that the pain can no longer be managed by medications, exercises, braces, or physical therapy, then it is time to evaluate for more invasive procedures such as arthroscopy or total knee replacement.
The evaluation starts with a thorough history and physical examination. Symptoms may include pain on simple activities such as walking or climbing stairs and in severe cases even at rest. Examination can include range of motion test, loose ligaments, tears such as Lachman sign, Drawer sign, McMurray sign, or crepitations underneath the knee cap. Upright weight-bearing x-rays are a good way to see how much cartilage is left. In the case of joint space narrowing to the point that it is bone on bone that is considered severe osteoarthritis and is an indication for Total Knee Replacement (TKR). If there is torn meniscus, arthroscopic surgery may be all that is required. An MRI of the knee will confirm the diagnosis.
Although Total Knee Replacements have been performed in the United States since 1968, the technology for these procedures has improved exponentially with the use of fibro optics, titanium, and matrix polyethylene plastic joint bearings instead of Teflon thus extending the life of the joint from 10 to up to 20 years. The new surgical techniques are much improved also. Cutting from the side and underneath vastus medialis muscle vs cutting in the front, reduces the recovery time from 8-12 weeks to just 3-4 weeks. The usage of new intra-operative and post-operative pain management techniques such as epidural anesthesia, general and long-acting local anesthesia, and IV patient controlled analgesia (PCA), help the patient recover faster by controlling the pain level. Icing the new knee, pain meds and anti-inflammatories are crucial in controlling pain and swelling. CPM (Continuous Passive Motion) machine is extremely important in recovery process as it promotes faster healing and prevents the scarring of the knee.
Your family doctor would be the person to advise you in your particular situation.
Preparation in the Event of a Helicopter Rescue
by Mark N. Monroe, M.D.
In the event that you or a crew member must be evacuated by helicopter, the U.S. Coast Guard will provide a specific list of instructions by radio. But if you know the procedure beforehand, you will be able to evacuate the injured person more quickly and efficiently.
Minutes can mean the difference between life and death, injury and health. A detailed log or record with an exact time must be kept and given to the authorities (i.e., sheriff, physician, paramedics) when requested. If you are not directly involved in the rescue, keep clear and don't get in the way.
Next, lower all antennae, bimini covers, outriggers, masts, booms, etc. Clear the deck of all loose gear and unnecessary personnel. If you have to move the victim, minimize jostling by log-rolling him/her. PUT A LIFE JACKET ON THE VICTIM with a note attached stating his condition and life signs (i.e., blood pressure, pulse, respirations, temperature (if available as in cases of hypothermia), and mental alertness (i.e., who he is, where he is, what happened, date and time) along with the recorded log as above in case the victim becomes unconscious or brain damaged from trauma or hypoxia (lack of oxygen) or air embolism (i.e., the bends from scuba diving).
When the helicopter arrives, the boat has to change course to put the wind 30 degrees off the port (left) bow as most helicopter hoists are located on their starboard (right) sides. Make contact with helicopter by VHF radiotelephone for further instructions. The rotors’ downdraft may make it difficult to control your vessel unless you maintain enough speed and steerage. The rotors are also loud, so have a designated person standing by in the cabin with a hand held VHF to relay messages or use an earphone jack.
A tether line will be lowered first into the water to dissipate any static electricity from the rotors which might shock the rescuer. Then a rescue device (i.e., a sling, litter, or basket) will be lowered on a steel cable. Have a crew member guide the rescue device into contact with your vessel. DISCONNECT THE CABLE AND LET THE HOOK END OF THE LINE GO FREE in order to put the victim in the rescue device.
DO NOT ATTACHE THE CABLE TO THE BOAT as each helicopter comes equipped with only one cable and has an automatic guillotine type cable cutter built into the winch in case of excessive load (i.e., your boat). That helicopter would have to fly back empty and a new helicopter would have to be sent out delaying the rescue.
Once the victim is in the rescue device, connect the cable only after the static electricity has been dissipated a second time. Then, signal the helicopter to hoist away with a "THUMBS UP" sign.
Hypothermia
by Mark N. Monroe, M.D.
Hypothermia, as defined by decreased body temperature, develops faster in water than air. Water conducts heat better than air. Any movement in the water accelerates heat loss reducing survival time to minutes depending on the temperature of the water.
Cold shock is defined as the sudden exposure to cold. The cold constricts blood vessels in the arms and legs causing low perfusion of muscles and tissues. Hands, arms and legs become numb and useless. Without thermal protection, swimming is difficult if not impossible.
The victim, though conscious, is soon helpless. Without a life jacket, drowning is unavoidable. As soon as the victim falls in the cold water, he experiences an involuntary gasp reflex. Just as his head goes under water, he inhales. Once the victim is in the water, he should try to get back in or on the boat immediately if it is still floating. If you cannot get out of the water, or do not have thermal protection, such as a wet suit or survival suit, stay as still as possible in the H.E.L.P. (Heat Escape Lessening Posture) position with folded arms and crossed legs, floating with your back to the waves.
If two or more people are in the water put your arms around one another in the huddle position until help arrives.
Treatment depends on the severity of hypothermia.
In mild hypothermia the victim is shivering, but coherent. Move victim to sheltered place of warmth. Remove wet clothes. Give warm (not hot) sweet drinks, but no alcohol or caffeine. Keep victim warm for several hours. Use your own body heat, if necessary.
In moderate hypothermia, the shivering may decrease or stop, but the victim is no longer coherent and may seem irrational with deteriorating coordination. Treat same as mild, but no drinks to prevent aspiration. Keep the victim lying down with his torso, thighs, head and neck covered with dry clothes or blankets to stop further heat loss. Seek medical attention immediately.
In severe hypothermia, the shivering has stopped, the victim may be semi-conscious or unconscious. Do not assume he is dead just because he is cold. The saying in the emergency room is: "Nobody suffering from hypothermia is dead until they are warm and dead". Victims have survived 45 minutes or longer under water due to a cold reflex that shunts the oxygenated blood to the vital organs while slowing their rate of metabolism prolonging their survivability. If pulse and breathing are totally absent, start CPR and call for immediate medical evacuation.
Plan ahead! Wear clothing by the "layer" effect. As the weather gets colder, put more layers on. As the weather gets warmer, take layers off. Personal flotation devices, such as life jackets especially for children, are the only ways to survive cold water emersion. Wool, nylon, polypropylene fabrics do not effectively prevent heat loss in cold water. Fleece-lined polartec clothing (Patagonia) is rated equal to 2.5mm neoprene and is comfortable under outer clothing. These can be found in catalogs and marine stores. Carry dry clothing in waterproof bags.
A short rope sling tied to the transom with a foot rest in the loop may assist boat re-entry. A lifesling or harness can help you stay with the boat. Attach a whistle and light to your life jacket to signal for help. Tell someone where you are going and when will you return. More men have fallen overboard with their zippers open. Have a safe boating experience!