In that case cheap toradol 10mg without a prescription, the crewmember had exhibited symptoms of mental infirmity and had actually jumped overboard at one point toradol 10 mg without a prescription. The evidence at the hearing showed that the crewmember was suffering from delirium tremens buy 10 mg toradol visa, as result of suddenly stopping heavy alcohol use discount toradol 10 mg on-line. An adequate guard was not placed over the crewmember, even after he had jumped overboard and had been rescued. The crewmember later killed himself by slashing his wrist with a piece of glass he had obtained from the bridge. The Coast Guard, holding that a person in such a condition must be guarded until he regained “mental composure and the ability to care for himself”, found the Master negligent in the license proceedings. Based on this ruling, the fact that the crewmember was not violent and was outwardly calm after having been shackled for a short period of time did not relieve the Master from his responsibility. The reasoning was that the crewmember had appeared to be rational before he had jumped overboard, but the act of jumping highly discredited any such appearances. In a similar case, a ship owner was found liable for contributing to the death of a seaman who disappeared at sea. In that case, the Master had been aware of the seaman’s severe psychiatric condition and was in possession 30 th Smith v. The court determined 31 that the seaman should have been under constant observation. Coast Guard determined a vessel’s Master used unreasonable force in subduing a mentally infirm crewmember, actually shooting and killing him. The decision discussed the right of Masters to use firearms to arrest a mutinous seaman, but contrasted this with a mentally infirm seaman, whose mental infirmity was known to the Master. Since the crewmember was not actively creating any danger to others in the crew, it was held that the Master’s duty to protect a mentally ill crewmember would predominate over his or her duty to make an arrest for purposes of discipline and protecting his or her authority in command. The seaman in this case was also suffering from delirium tremens, and the “Ship’s Medicine Chest” was sited in discussing the proper treatment of a crew member so afflicted. Although not discussed, the Master may have been subjected to criminal penalties in that case. The salient difference between this situation and others discussed thus far is that the Master here, although aware of the hallucinations of the crew member, was not sufficiently apprised of any tendency toward violence or self- injury. Coast Guard stated: “While the shipmasters have well defined responsibility, including timely and apt measures for protection of their crew members, the evidence of this case falls far short of establishing culpable fault or negligence against this shipmaster. The deranged crew member had committed no violence to either his shipmates or himself. He had readily responded to the reasoning of his shipmates; and those who were in more close association with him than the Master were reluctant to even suggest much less recommend his confinement. An appellate court found negligence where a Master of a vessel made no attempt to search for a seaman who was not reported missing until 5 hours after he was last 32 seen. The Court of Appeals stated: “We think the Court was in error (referring to the lower court) in its basic premise that Gardner was overboard soon after he was last seen. Unless such a search was made by that or other vessels in the area, it could not be determined that Gardner was beyond rescue. In this case the Master turned the vessel back on its course, but stopped searching when darkness fell, 70 miles from the place where the vessel had been when the seaman had last been seen. The court stated: “A series of speculations must all be indulged in and resolved in favor of the missing crew member in order to find any basis for saying that he could possibly have stayed afloat and alive long enough to be pulled up. Each of these speculations must also reach a result which is contrary to the overwhelming probabilities. This is necessary because it is usually unclear whether or not the crewmember fell overboard just after he or she was last seen, or just before he or she was noted to be missing. There is, however, a rule of reason applied as to when the search can be called off. When the probabilities are that the crewmember will not be rescued, it is doubtful that the U. A Master’s responsibility, of course, does not completely end when an injured or infirm crewmember dies during a voyage. Even if the Master has acted reasonably and well up to that point, he or she is still tasked with certain duties concerning the deceased crewmember. If the seaman’s death occurs at sea, such money, property, or wages shall be delivered to district court or a consular officer within one week of the vessel’s arrival at the first port call after the seaman’s death. Pre-planning for medical situations and acting responsibly when problems arise will be helpful in avoiding legal liability. For practical purposes, significant risk of immersion hypothermia usually begins in water colder than 77° F. This means that the risk of immersion hypothermia in North America is nearly universal during most of the year. Cold water immersion is associated with two significant medical emergencies: near drowning and hypothermia. The following pages discuss these topics, with emphasis on the body’s response to immersion and on the treatment of hypothermia and near- drowning. This reflex causes an instantaneous gasping for air and sudden increases in heart rate, respiratory rate, blood flow and blood pressure. The cold-shock reflex (see below for a more complete discussion) only lasts for a few minutes, but it can be deadly if the victim’s head is underwater (leading to immediate aspiration and drowning) or if the victim has no flotation assistance and cannot keep his/her head above the water. Also, the muscles of the extremities cool rapidly, leading to a loss of manual dexterity and grip strength. As the body continues to cool, shivering eventually ceases, heart rate and blood pressure decrease, and the victim begins to suffer mental impairment, difficulty in thinking clearly, impaired perception, and finally loss of consciousness. An unconscious victim in the water will drown, oftentimes even if he/she is wearing a personal flotation device. If an immersed unconscious hypothermia victim does not drown, continued body cooling will eventually lead to cardiac arrest. Oral temperatures and axillary (armpit) temperatures are not accurate in hypothermia. Shivering; impaired manual dexterity, grip strength and muscle coordination; impaired mental processes. Extremity stiffness; vital signs difficult to measure or absent; severe risk of ventricular fibrillation or cardiac arrest from rough handling during rescue or treatment; cardiac arrest or ventricular fibrillation usually occurs spontaneously at body temperatures below 77° F. The body’s responses to cold-water immersion can be divided into three stages: 1) initial immersion and the cold-shock response; 2) short-term immersion and loss of performance; and 3) long-term immersion and the onset of hypothermia. Each phase is accompanied by specific survival hazards for the immersion victim from a variety of physiological mechanisms. Stage 1: Initial Immersion: the Cold Shock Response: The cold shock response occurs within the first 1-4 minutes of cold water immersion and is dependent on the extent and rate of skin cooling. The responses are generally those affecting the respiratory system and those affecting the heart and the body’s metabolism. Rapid skin cooling initiates an immediate gasp response, the inability to breath-hold, and hyperventilation. The gasp response may cause drowning if the head is submersed during the initial entry into cold water. The significant lessening of breath holding time makes it more difficult to escape underwater from a capsized vessel, and it further increases the risk drowning in high seas. Finally, hyperventilation may cause a low level of blood carbon dioxide, which can lead to decreased brain blood flow and oxygen supply. Skin cooling also initiates peripheral vasoconstriction (the constriction of small blood vessels in the skin and superficial tissues) as well as increased cardiac output, heart rate and blood pressure. The increased workload on the heart may lead to myocardial ischemia (low blood oxygen levels in the heart muscle) and arrhythmias (abnormal heart rhythm), including ventricular fibrillation. Thus, sudden death can occur either immediately or within a matter of minutes after immersion in susceptible individuals (i. Stage 2: Short-Therm Immersion: Impaired Performance: For those surviving the cold shock response, significant cooling of muscles and other soft tissue, especially in the extremities, continues with most of the effect occurring over the first 30 minutes of 10-2 immersion. This cooling has a direct negative effect on neuromuscular activity (nerve and muscle control). This effect is especially significant in the hands, where blood circulation is negligible, leading to finger stiffness, poor coordination of gross and fine motor activity, and loss of power. It has been shown that this effect is primarily due to peripheral and not central cooling. The loss of motor control makes it difficult, if not impossible, to execute survival procedures such as grasping a rescue line or hoist, operating a radio, using signaling devices, etc. Thus the ultimate cause of death is drowning, either through a failure to initiate or maintain survival performance (i.

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A sudden drop in blood pressure can cause any of the following: • Dizziness • Light-headedness • Confusion • Headache • Shoulder and/or neck pain If you have a very big blood pressure drop 10 mg toradol with mastercard, you can black out and fall order toradol uk. Falling blood pressure is part of the You can manage blood pressure disease process purchase toradol 10 mg fast delivery. This happens when drops by doing the following: nerve cells in areas of the body that • Avoid standing up too quickly toradol 10 mg amex. Although certain Parkinson’s • Raise the head of your bed when medications can make this problem you sleep. If you are taking high blood pressure medications or other medications that can lower your blood pressure, the frst step would be to lower the strength of these medications. Changes can range from a lower (or sometimes higher) sex drive, to problems with having an orgasm. It is also possible for your sex drive to go up after starting dopamine medications. Changes in sexuality can be part of the disease process, as this is caused by dying nerve cells. That said, many other conditions can cause these changes too: • Trouble with erection can be caused by diabetes, high blood pressure or being overweight. Keep in mind that an abnormally high sex drive can also be brought on by certain medications, which cause problems with impulse control (see page 114 to learn more). If you are having trouble with sexual dysfunction, consider other forms of intimacy. If you are a man, your doctor may suggest medications Keep in mind that there is a chance like Sildenafl (Viagra) of tadalafl of having certain possible health (Cialis) for erection problems. Always speak with your If you are a woman, your doctor might doctor before taking any hormones suggest hormone medication to help or medications for sexual problems. Amantadine medication can sometimes cause color changes in your legs, along with swelling. You can manage leg swelling by doing the following: • Wear compression (or support) stockings. Heavy sweating usually happens Finally, heavy sweating can during “off” periods (that is, when occasionally happen even without the medications are wearing off). We do also can happen during dyskinesia not know the exact reason for this (increased movements, see page problem. There is no specifc treatment for heavy sweating, as this is usually not a serious health problem. If it happens when your medications are wearing off, it is important to share this with your doctor. He or she may change the timing of your medications, which could make all the difference. Key points * This usually happens during “off” periods (that is, when the medications are wearing off), * It can also happen when you have dyskinesia (increased movements), as in many ways, these extra movements are a form of muscle exercise. However, if you have unexplained pain, especially in the muscles, this may be Parkinson’s pain. With Parkinson’s pain, you may feel: • Stiffness, cramps, spasms or other muscle pain. If you noticed Parkinson’s changes on one side of your body frst, this is usually where it is more painful. The stiffness and unusual postures that come with Parkinson’s disease may lead to muscle aches, cramps and joint pain. If the pain happens Also, another clue is if pain happens more on the side where the as you feel your medications are Parkinson’s is more severe, this “wearing off”. Parkinson’s may also may be a clue that it is related to make you somewhat more sensitive Parkinson’s. If these do not help, speak with your doctor about over-the-counter pain medications (e. Speak to you doctor if you have He or she may increase the strength strong or intense pain. Many people of your medications, or change your have pain during “off” periods (times timing. If this is the case for you, ask your doctor may suggest you take your doctor how you might be able to other pain medications. Drooling refers to a buildup of saliva, which can lead to saliva leaking out of the mouth. You may feel as though your body is making too much saliva, but this is not the case. This means that you are not naturally swallowing your saliva, so it builds up in your mouth. This is because keeping something in your mouth gives you an unconscious reminder to swallow. If you have memory problems or suffer from hallucinations, discuss this with your doctor, because you will then need to use atropine with care. If you use this medication, you will need injections every few months (3 to 4 months). This happens when nerve cells in the areas of the brain that control swallowing don’t work well. Try the following to help manage To avoid choking: trouble swallowing: • Take extra care to make sure • Chew your food well before your mouth is clear before talking. If choking continues to happen, there is a chance that food can go down the wrong passage and end up in your lungs. Medications that treat Parkinson’s movement problems can sometimes help with swallowing. These therapists are For very serious swallowing and specialized in swallowing problems. They this is starting to happen to you, it may may suggest certain types of food be useful to begin planning ahead of that are easier to swallow (e. They will also explain caregivers, if this is something that how proper posture while eating can you would eventually wish. Key points * This should not be taken lightly as it can lead to choking or pneumonia (lung infection). You tend to see double when your Speak to your doctor if you notice eyes drift apart. Medications taken for like the rest of the muscles in your Parkinson’s movement problems body. Your doctor may refer you to an ophthalmologist (eye specialist) to confrm that there is no other cause. Some people may have some Keep in mind that forgetting some trouble with attention, thinking information sometimes is normal and memory. Dementia refers to a much more serious failing of memory and thinking skills that affects day-to-day activities. Changes in mental ability happen There are some very early studies as the disease starts to spread into (not yet proven in Parkinson’s), the parts of your brain that control which suggest that the following may attention, thinking and memory. You will need to discuss strategies, supportive care and other resources to help you manage. If you are starting to have more serious memory problems, make sure that: • A trusted caregiver has power of attorney. In case you are no longer able, power of attorney will give this person the right to speak for you, arrange your fnances, pay your bills and more. You will not be able to change your will if you have severe attention, thinking or memory problems. Medications, such as rivastigmine (Exelon), galantamine (Reminyl) and donepezil (Aricept), can help. For this reason, always make sure your doctor knows about all the medications you are taking. Key points * Common changes include problems with memory, planning, attention, and slowing of thoughts. Some medications can sometimes cause attention, thinking and memory problems or make them worse.

F. Sulfock. West Virginia State University.