DESRON 15 MEDICAL MEETING 26 AUG 2016 MEETING

DESRON 15 MEDICAL MEETING 26 AUG 2016 MEETING

DESRON 15 MEDICAL MEETING 26 AUG 2016 MEETING AGENDA Introductions Round Table updates Chest Pain Lecture/Presentation Influenza Season Physicals Green H Package initial review

MEDEVAC Review FSOM Certification Preparation Monthly Reports SMO Coverage Round Table Updates UPDATES FROM EXTERNAL COMMANDS -LIMDU COORDINATOR -DENTAL LIAISON -PHYSICALS DEPARTMENT

CHEST PAIN A TALE OF THREE PATIENTS 49 yo Hispanic Male, URI past few weeks, now p/w one week history of exertional chest discomfort and assoc. bilateral arm weakness, improves with rest. No sig risk factors, nonsmoker, physically active, no fam history, vitals WNL, and exam unremarkable. Ship underway, just pulled into foreign port. I. II. III.

IV. IDC started prednisone, metoprolol, aspirin, lipitor underway EKG in-port shows 1st degree heart block, otherwise normal CXR clear Labs are normal, Cardiac enzymes not available in this port A TALE OF THREE PATIENTS 38 yo AA Male, p/w 2 days of intermittent chest tightness with assoc. lightheadedness and left arm numbness. Symptoms present at rest, with SOB going up ladderwells. History sig for ADPKD, not

currently on meds. No other risk factors. V/S sig for HR in 40s-50s at rest/sleep. Otherwise WNL. Exam unremarkable with exception of mild diaphoresis. No labs. Ship underway off the coast of Japan. I. IDC started ASA 81 mg, and O2 2L by NRB II. No change in symptoms after 30 minutes III. QBC star not working (surprise, surprise) A TALE OF THREE PATIENTS 39 yo AA Male, URI recently, now p/w 2 day history of sharp-stabbing chest and back pain rated 8/10 and mild lightheadedness. Tried Motrin, no help. No sig risk factors, nonsmoker, physically active, no fam history,

vitals WNL, and exam unremarkable. Ship underway, just pulled into port near MTF. I. II. III. IV. V. IDC started Mobic underway EKG in-port shows NSR CXR clear, questionable mediastinal widening vs. artifact

Initial labs are normal Patient doesnt feel well Feels like something bad is going to happen Medical capabilities of a DDG CBC, UA, SUPER SMART IDC AND A TELEPHONE! E PAIN MATTERS

OPQRST Onset- When did the symptoms start AND what were you doing? Provocation/Provoking- What makes you pain better or worse? (EXERTION, LAYING FLAT, FOOD) Quality- What does your pain feel like (sharp, ripping, dull, pressure, burning)? Tightness/discomfort = Pain Radiation- Does your pain radiate? Where to (neck, jaw, arm, back, legs)? Severity- 1 to 10 scale Time- When did your pain start? PEARL- Other weird symptoms? N/V/D, Diaphoresis, back/leg/testicular pain, syncope, lightheaded

HISTORY AND RISKS HISTORY AND RISKS HISTORY, HISTORY, HISTORY MEDS-? (lipid meds, BP meds, cardiac meds) PAST/CURRENT MEDICAL- HTN, HLD, ADPKD, Heart problems, GERD, Trauma, Genetic disorders, Lung problems, Diver, SURGERIES- heart, lung, abdomen? LABS or XRAYS, etc?- Check the chart, and AHLTA if available.

Often find clues, or abnormal labs that were missed or ignored. ACTIVITIES?- Recent drinking, MCMAP, PRT, Vomiting, Overeating, Travel (plane flight CONUS) EXAM GEN- HOW DO THEY LOOK? (GREY, SWEATY, PALE, SICK) CHEST- LOOK, LISTEN, FEEL. (MURMURS, MOVEMENT, BRUISES) LUNGS- LOOK, LISTEN, FEEL. (WHEEZING, RUBS, QUIET) ABDOMEN?- PAIN CAN BE REFERRED LEGS, ARMS, BACK- QUICK CHECK, SWELLING (PITTING OR

NOT?), TENDERNESS, WEAKNESS, PULSES AND BP (BOTH ARMS) NOW WHAT? ANY CHANCE FOR AN MI? GIVE 325 MG ASA, START OXYGEN, 2-4 L NC. (risk of harm from aspirin is lower than my chances of getting a date with Megan Fox) GIVE A PPI (cover for GERD/Ulcer).

PHONE A FRIEND CALL ME DONT TRY TO DO THIS YOURSELF. BE GOOD HISTORIAN, THEN CALL. CONCISE PRESENTATION. ILL ASK QUESTIONS. NEARLY ALL WILL REQUIRE EKG/CXR, WHICH MEANS NEARLY ALL MUST LEAVE THE SHIP MANY OR MOST WILL BE FALSE ALARM. JUST ACCEPT IT. A TALE OF THREE PATIENTS

49 yo Hispanic Male, URI past few weeks, now p/w one week history of exertional chest discomfort and assoc. bilateral arm weakness, improves with rest. No sig risk factors, nonsmoker, physically active, no fam history, vitals WNL, and exam unremarkable. Ship underway, just pulled into foreign port. IDC started prednisone, metoprolol, aspirin, lipitor underway. EKG in-port shows 1st degree heart block, otherwise normal. CXR clearLabs are normal, Cardiac enzymes not available in this port I. II. III.

IV. V. Sent to Singapore. Gut feeling. (ship CO, about to retire) EKG in Singapore showed mild ST depression in I and AVL Troponin was 34 (nml is 15 max) Taken to Cath Lab 90% stenosis of LAD (aka the WIDOWMAKER) with two additional 75% lesions. VI. Received 4 stents, put on meds, flown CONUS

A TALE OF THREE PATIENTS 38 yo AA Male, p/w 2 days of intermittent chest tightness with assoc. lightheadedness and left arm numbness. Symptoms present at rest, with SOB going up ladderwells. History sig for ADPKD, not currently on meds. No other risk factors. V/S sig for HR in 40s-50s at rest/sleep. Otherwise WNL. Exam unremarkable with exception of mild diaphoresis. No labs. Ship underway off the coast of Japan. IDC started ASA 81 mg, and O2 2L by NRB. No change in symptoms after 30 minutes. I. II.

III. IV. V. MEDEVACd to Japan via RHIB. EKG on pier was WNL. Cardiac eval at ER was normal Given GI cocktail in ER, symptoms resolved Diagnosed with GERD, f/u with IM A TALE OF THREE PATIENTS

39 yo AA Male, URI recently, now p/w 2 day history of sharp-stabbing chest and back pain rated 8/10 and mild lightheadedness. Tried Motrin, no help. No sig risk factors, nonsmoker, physically active, no fam history, vitals WNL, and exam unremarkable. Ship underway, just pulled into port near MTF. IDC started Mobic underway. EKG in-port shows NSR. CXR clear, maybe some mediastinal widening. Initial labs are normal. Patient doesnt feel well Feels like something bad is going to happen I. D-Dimer elevated on secondary labs II. CT-A ordered on a hunch III. Massive Aortic dissection noted on CT-A, from Left subclavian to

the iliacs, with partial occlusion of left Renal IV. Started on Metoprolol V. Flown to nearest civilian center, total Aortic replacement with synthetic graft. 14 hours case, three surgeons. Influenza vaccine 2016-2017 Initial Flu Vaccine scheduled to start in September Make sure to have plenty of supplies available. May come to DLA while youre underway. If your shipment comes with Temptale, mail out per instructions prior to starting ship-wide shot ex.

Only injectable Influenza will be available Afluria MDV code 141 Flulaval MDV code 158 Contact CDS15 Medical if you have questions Physicals Guidance Separation Physicals Follow guidance in Physicals Packet coversheet on CDS15 website.

Give CDS15 Medical 2 weeks notice. Too many last minute routine separation physicals. ADMIN separations will get done, just let us know as soon as you know. Conduct HAIMS push via Medical Records at USNH Yokosuka. Dome Dive/SEAL Physicals Requires UMO sign off. Packet located on CDS15 website. We can assist with scheduling at SUBGRU 7, LT Harge(UMO) Green H Package Reviews Green H Package Drafts

Initial Green H packages are due to DESRON 15 Medical the week of Thanksgiving(or when you pull back in). Submit in 3 ring binder, with all content broken down by Enclosures. Include copy of your own self assessment check sheet. Final Draft must be completed and signed by CoC and forwared to DESRON by 16 Jan 2017 for Commodores endorsement. Green H Binder will be shipped to CNSP for the board(normally due mid February). Board will be in March, results normally returned April/May.

MEDEVAC Process Reminder Follow CDS15 guidance NMA required for all MEDEVAC. Same rank and above recommended, but not required. DESRON 15 Reports Items that we will be tracking while inport/underway Monthly Requirements: Quarterly Requirements:

1. SHIPS AMMAL QOB Report 1. Green "H" quarterly meeting minutes. 2. IDC NOTES for REVIEW Due 3rd Friday of the month 3. MRI Checklist: 1 Chapter binder reviewed during a visit while in port. Self assessment on an MRI

chapter if underway. 2. Quarterly Review report for IDC Training record. 3. Copy of Quarterly CSIB SMO Coverage LT Roderique on leave 06-21 September Contact SMO for CTF 70, CDR Wilson while underway for advice or consultation. If unreachable, contact USNH Yokosuka Emergency Room for on

call doctor. QUESTIONS OR COMMENTS?

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