Monthly Medical Waterfront Meeting

30APR 2015

Waterfront Rec Center: 32nd NAVSTA San Diego

  1. Introductions
  2. LT Hightower
  3. Pretest
  4. Opening Remarks by CAPT Laverty and HMCM Davis, CNSP
  1. Airway Management at Sea
  2. Dr. NielsHauff, LT MC USN, NMCSD Anesthesiology
  3. Airway Defined
  4. Anatomic Airway
  5. Airway Protection and Reflexes
  6. Level of Consciousness
  7. Glasgow Coma Scale
  8. GCS of 8 or less is not an absolute indication for intubation
  9. Oxygenation and Ventilation
  10. Oxygenation easily measured with SpO2
  11. Adequacy of ventilation more difficult to assess
  12. Muscle strength
  13. Respiratory failure may be secondary to weakness
  14. Airway Pathology
  15. Airway Assessment
  16. Ask questions, Obtain vitals and SpO2, Obtain history which will aid in diagnosis
  17. Signs/Symptoms of inadequate airway
  18. Maxillofacial or neck trauma
  19. Stridor  Silence
  20. Tachypnea
  21. Accessory Muscles
  22. Secretions
  23. Singe or Soot
  24. Voice quality, hoarseness
  25. Mental Status, GCS
  26. Gag/Cough reflex
  27. Vital Signs- Pulse oximetry, Capnography
  28. Airway Management
  29. Apply supplemental O2
  30. Open airway
  31. Simple airway maneuvers
  32. Be suspicious of C-spine injuries – in line immobilization or C-collar
  33. Basic Airway Adjuncts
  34. Nasopharyngeal and Oropharyngeal Airway
  35. Bag-Valve-Mask Ventilation
  36. Invasive Airway
  37. King-LT, LMA
  38. Intubation Underway
  39. Pros
  40. Pathology may require an invasive airway as life saving treatment
  41. Cons
  42. Unable to monitor adequacy of ventilation
  43. Long term sedation difficult
  44. No ventilator
  45. Alters ships operations
  46. Patient Positioning
  47. Rapid Sequence Induction
  48. Ensure functioning IV, patient on monitors
  49. Suction, Ambu bag, Laryngoscope, Endotracheal Tube
  50. Pre-oxygenate
  51. Crycoid pressure
  52. Etomidate 0.2-0.5mg/kg- 15-20mg usual dose
  53. Succinylcholine 1mg/kg- 100mg usual dose
  54. Direct Laryngoscopy
  55. Failed Intubation
  56. Attempt mask ventilation
  57. Consider placing LMA or King LT
  58. If 1st attempt fails, change something for next attempt
  59. Position
  60. Blade
  61. Operator
  62. Surgical airway
  63. Confirm ETT placement
  64. Breath sounds, chest rise, Easy-Cap
  65. Post Intubation management
  66. Sedation
  67. Morphine 2-5mg IV q 15 minutes
  68. Sedatives if available
  69. Titrate to patient’s requirements
  70. Ongoing ventilation
  71. ABG if available
  72. 5-7cc/kg tidal volumes
  73. 10-12 breaths per minute
  74. Treat underlying cause
  75. Airway Lab
  1. Post Tests
  1. Fleet Dental – CAPT Roncone, Dental Updates
  1. COMLCSRON – HM1 Cahill – Enlisted Advancement Review Course (EARC)
  1. Old Business
  2. Upcoming Mind Body Medicine
  3. Next class is April 9-10 at NMCSD Chapel Fellowship Hall
  4. Register with CDR Millegan ()
  5. LARC Clinic
  6. Email Dr. Marengo to reserve a clinic day
  7. Primary Care Symposium
  8. 8 MAY 2015, Friday at NMCSD
  9. Active Duty Clinic-Gen Surgery
  1. Upcoming Meetings
  2. May 27th @ 1000-1200
  3. Ultrasound (GMOs)
  4. Dentistry for the IDC (IDCs)
  5. SAFE testing (primary date)
  6. June 30th @ 1000-1200
  7. Acute Drug Reactions/Allergies
  8. Drug Overdose/Antecdotes + NG Tubes/Gastric Lavage
  9. SAFE testing (alternate date)
  10. July 29th @ 1000-1200
  11. Trauma
  12. Psych Emergencies
  13. August 27th @1000-1200
  14. X-ray interpretation (GMOs)
  15. Pelvic/speculum exam (IDCs)
  16. CME Information