International Medical Guide for ships, including the ship's medicine chest (3rd edition). Международное руководство по судовой медицине, включающее судовую аптеку.

Артикул: 00808059
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Место издания: Женева
Год: 2005
Переплет: Твердый переплет
Страниц: 470
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См. также переводное издание Международное руководство по судовой медицине 3 -е издание
Seafaring has always been a dangerous occupation. Long voyages, extreme weather conditions, illnesses and accidents can take a heavy toll on the health of crew members. Not only are they exposed to greater risk, seafarers are also isolated from the usual sources of medical care and assistance available to people on shore.
WHO has consistently strived to improve the health of people at their place of work. When people also live in their work environment - as seafarers must - they face particular risks to their health. Practical guidance is essential for those who must provide assistance when seafarers fall ill or are injured. Since its first publication by WHO in 1967, the International Medical Quide for Ships has been the standard source of such guidance.
The second edition, written in 1988, was translated into more than 30 languages, and has been used in tens of thousands of ships. This, the third edition, contains fully updated recommendations aimed to promote and protect the health of seafarers. This edition is also consistent with the latest revisions of both the WHO Model List of Essential Medicines and the International Health Regulations (2005).

The International Labour Organization (ILO) Maritime Labour Convention 2006 stipulates that all ships shall carry a medicine chest, medical equipment and a medical guide. The International Medical Quide for Ships supports a main principle of that Convention: to ensure that seafarers are given health protection and medical care as comparable as possible to that which is generally available to workers ashore, including prompt access to the necessary medicines, medical equipment and facilities for diagnosis and treatment and to medical information and expertise.

The Convention states that ships carrying 100 or more persons and ordinarily engaged on international voyages of more than three days' duration shall carry a qualified medical doctor who is responsible for providing medical care. Ships which do not carry a medical doctor shall be required to have either at least one seafarer on board who is in charge of medical care and administering medicine as part of their, regular duties or at least one seafarer on board competent to provide medical first aid. Persons in charge of medical care on board who are not medical doctors shall have satisfactorily completed training in medical care that meets the requirements of the International Convention on Standards of Training, Certification and Watchkeeping for Seafarers. The International Medical Quide for Ships is a standard reference for these training courses, and is designed for use by all crew members charged with providing medical care on board.

The ILO Maritime Labour Convention 2006 stipulates that the competent authority shall ensure by a prearranged system that medical advice by radio or satellite communication to ships at sea is available 24 hours a day - the International Medical Quide for Ships explains when it is essential to seek such advice.

By carrying this guide on board ships, and following its instructions, countries can both fulfill their obligations under the terms of the Maritime Labour Convention 2006, and ensure the best possible health outcomes for their seafaring population. WHO is pleased to be able to contribute to this goal by presenting the third edition of the International Medical Quide for Ships.





How to use this guide

1 First aid
First aid on board
A basic life support sequence

2 Shock

3 Pain management

4 Head injuries
Anatomical note
General note on head injuries Skull fractures
Traumatic brain injury (brain damage) Post-concussion syndrome

5 Eye injuries and diseases
Eye injuries Red flags
A blow on or near the eye Cornea! abrasion Loose foreign bodies Foreign bodies embedded in the eye Wounds of the eyelids and eyeball Chemical burns Arc eyes ("welder's flash")
Noninfectious eye diseases Subconjunctival haemorrhage Cataract Glaucoma
Infectious eye diseases Blepharitis Conjunctivitis Keratitis Hordeolum
Sudden painless loss of vision

6 Bone, joint, and muscle injuries
General treatment of injuries
Specific injuries Strains and sprains Compound fractures
Skull fractures
Nose, jaw, and face fractures
Neck (cervical spine) injuries
Collar bone (clavicle) injury
Shoulder injury
Injury to the upper arm (humerus) and elbow
Wrist and forearm fractures
Hand and finger injuries
Rib fractures
Fractures ofthepelvis, hip, and femur
Knee injuries
Shin (tibia and fibula) fractures
Ankle injuries
Fractures of the foot and toes
Splints and slings

7 Abdominal and chest injuries
Abdominal injuries Blunt abdominal injuries Penetrating abdominal injuries
Chest injuries
Simple rib fracture Flail chest Pneumothorax Spontaneous pneumothorax Tension pneumothorax Penetrating chest wounds

8 Wounds
Wound healing Red flag wounds How to close a wound
Using adhesive skin closures Using skin adhesive (liquid stitches) Suturing a wound
Local anaesthesia Special wounds
Ears and nose
Puncture wounds of the soles of the feet
Wound infection
Dressing wounds that cannot be closed

9 Burns, chemical splashes, smoke inhalation, and electrocution
Clothing on fire Heat burns and scalds
Infection of a burn Respiratory tract burns
Electrical burns and electrocution
Chemical splashes
Flash burns (arc eye)
Smoke inhalation

10 Heat stroke and other heat disorders
Heat stroke
To prevent heat stroke Stoker's cramps Heat exhaustion (or "heat collapse")

11 Poisoning
Poisoning with ingested drugs and chemicals
Red flags
Common poisoning agents
Paracetamol (acetaminophen)
Acetylsalicylic acid (Aspirin*)
Methanol and ethylene glycol
Organophosphate and carbamate insecticides
Anticoagulants (warfarin, rat poison)
Petroleum products
Disinfectants and bleach
Dangerous prescription drugs
Poisoning from exposure common to gases or vapours
Carbon monoxide
Irritant gases - phosgene, chlorine, ammonia
Carbon dioxide
Flammable liquid vapours
Hydrogen sulphide ("Rotten egg gas", "Sewer gas")
Bites and stings
Rat bites Snake bites Jellyfish stings Venomous fish Sea urchins Scorpions and spiders

12 Examination of the patient
Privacy and confidentiality
The physical examination

13 Paralysis, strange behaviour, unconsciousness
Stroke Transient ischaemic attack (TIA)
Headache Red flags
Seizures and epilepsy Types of epileptic seizure Red flags Drugs that can precipitate seizures
Loss of consciousness Sudden loss of consciousness (syncope) Finding an unconscious person Diabetes mellitus and coma Diabetic ketoacidosis Hypoglycaemia
Bell's palsy
Mental illness Psychosis Forms of psychosis Depression
Violent or threatening behaviour Suicide
After an unsuccessful suicide attempt Post-traumatic stress disorder

14 Chest pain and other disorders of the heart and circulation
Angina pectoris Complications ofmyocardial infarction Palpitations
Blocked arteries in the legs Deep vein thrombosis

15 Respiratory diseases
Bronchitis due to infection Bronchitis due to cigarette smoking
Bronchiectasis Common cold
Pleurisy Pneumothorax
Lobar pneumonia
Aspiration pneumonia and lung abscess
Sinusitis Hay fever Asthma

16 Gastrointestinal and liver diseases
Abdominal pain - general points
Red flags in abdominal pain
Severe abdominal pain
Appendicitis Pancreatitis Bowel obstruction
Diarrhoea Foodborne illness Dysentery Traveller's diarrhoea Food poisoning from marine toxins Inflammatory bowel disease (colitis) Ulcerative colitis Crohn's disease Antibiotic-associated colitis
Indigestion and pain related to meals Gastro-oesophageal reflux disease Peptic ulcer Red flags
Heavy bleeding from the gastrointestinal tract (gastrointestinal haemorrhage) Heavy upper gastrointestinal bleeding Heavy lower gastrointestinal bleeding Anal fissure Haemorrhoids (piles) Analpruritis (anal itch)
Hernia Inguinal (groin) hernia
Liver and biliary disease Jaundice Liver failure Alcoholic liver disease Gallstones

17 Kidney and other urinary disorders
Disorders of the kidney Acute renal (kidney) failure Chronic renal failure (Bright's disease) Kidney stones (renal colic)
Other urinary disorders Red urine
Urinary tract infection Urinary tract infection in women Urinary tract infection in men Prostatitis
Chronic pelvic pain in men Benign prostatic hyperplasia (BPH, enlarged prostate) Acute urinary retention

18 Pregnancy and childbirth
Pregnancy Drugs in pregnancy
Vaginal bleeding during pregnancy or suspected pregnancy
Ectopic pregnancy
Salpingitis (inflammation of a fallopian tube)
Pruritus vulvae (external genital itching)
Childbirth Preparing for the birth Managing the early stages of childbirth Managing the birth Caring for the baby after delivery Caring for the mother after delivery Post-partum haemorrhage Other possible problems after childbirth

19 Sexually transmitted infections
Urethritis in women Gonococcal proctitis Gonococcal pharyngitis Genital ulcers
Acute pain in the scrotum Epididymitis Testicular torsion Trauma to the scrotum Testicular inflammation (orchitis)
Lymph node swelling in the groin
Vaginal discharge Bacterial vaginosis Vaginal candidiasis Trichomoniasis
Pelvic inflammatory disease Ano-genital warts Pubic lice
Acquired immunodeficiency syndrome (AIDS) Later stages of HIV and AIDS Treatment of HIV infection Post-exposure prophylaxis

20 Skin diseases
Questions to ask a patient
Barber's rash Folliculitis
Pseudofolliculitis (also called "razor bumps") Tinea barbae
Acne Chaps
Dermatitis Irritant contact dermatitis Eczema (atopic dermatitis) Allergic contact dermatitis
Fungal skin infections Tinea pedis (athlete's foot) Tinea corporis (ringworm) Tinea cruris (Jock itch, Dhobieitch)
Bacterial skin infections Impetigo Carbuncles and furuncles (furunculosis)
Skin abscess
Pediculosis (lice infestation)
Shingles (herpes zoster and varicella zoster)
Urticaria (hives)
Cellulitis and erysipelas
Cellulitis arising from wounds exposed to estuary or seawater

21 Bone, joint, and muscle disorders
Joint inflammation
Septic arthritis
Rheumatoid arthritis
Problems in specific joints The knee The shoulder The back Red flags The neck Red flags

22 Tobacco, alcohol, and drug use
Four main questions to consider
Alcohol intoxication Alcohol withdraw! Minor withdrawal ("the shakes") Major withdrawal (delirium tremens, DTs)
Cannabis intoxication
Opioids, opiates, and related drugs Heroin intoxication Heroin overdose Infection in heroin users Heroin withdrawal
Other opioids
Cocaine ("coke", "snow", etc.)
Hallucinogen intoxication Lysergic and diethylamide (LSD) Phencydidine ("PCP" "angel dust") Plant hallucinogens
"Flashbacks" Kava kava

23 Infectious diseases
Infectious agents How infections spread
Common terms used in connection with infections Onset Fever Rash
Management of infectious diseases - general principles Isolation Needle-stick injuries
Treating infectious diseases Food
Some common or important infections that could occur on board Anthrax
Chickenpox and shingles (varicella-zoster virus) Cholera Dengue Diphtheria Ear infections
Hand infections in seafarers and fishers Infectious mononucleosis (glandular fever) Influenza Malaria
Meningitis and meningococcal infection Mumps Plague Rabies
Rubella (German measles) SARS (severe acute respiratory syndrome) Sore throat Red flags Tetanus (lockjaw) Tuberculosis
Typhoid and paratyphoid fever Viral hepatitis (hepatitis A, B, and C) Whooping cough (pertussis) Worms Yellow fever

24 Dental problems
Some common dental problems Tooth decay (caries) Pulpitis and peri-apical abscess Periodontal disease (gum inflammation) Pericoronitis Red flags
Lost fillings and broken teeth A bleeding socket Lost teeth

25 External assistance
Medical advice
Evacuation by helicopter
Ship-to-ship transfer of doctor or patient
Referral information to accompany evacuated patients

26 Nursing care and medical procedures
Nursing care
Preparing sick-quarters
First steps on a patient's arrival
Basic principles of nursing care
Caring for the bed-bound patient
Monitoring the vital signs
Bodily functions
Examining faeces, urine, sputum, and vomited matter
Mentally disturbed patients
The unconscious patient
Medical procedures
Applying cold
Applying heat
Catheterizing the urinary bladder
Surgical dressings
Administering medicines - basic principles
Routes of administration
Eye medication
Ear medication

27 Death at sea
Signs of death Examining a dead body Disposal of the body Burial at sea

28 Medical care for survivors at sea
Abandoning ship Surviving in a survival craft
Generalized hypothermia due to cold water immersion
Cold exposure injuries
Immersion foot (trench foot)
Other medical problems aboard survival craft
Dehydration and malnutrition
Heat exposure
Contamination with oil
Food and water for rescued survivors Medical resources on a lifeboat

29 Environmental control and hygiene
Ventilation Lighting
Food hygiene Food-handlers Food service facilities Food storage The galley (ship's kitchen) Toilet and washing facilities
Liquid transport and potable water Potable water sources Potable water transport system Potable water storage Taking water on board Disinfection of potable water
Disposal of liquid and solid wastes
Combating disease vectors Rodents Insects Flies
Mosquitoes Cockroaches Bedbugs
Sanitary inspection

30 Preventing disease and promoting health in seafarers
Preventing communicable diseases
Isolation Immunization Hepatitis A and hepatitis В Other infections
Preventing other diseases
Stopping smoking
A balanced diet
Personal hygiene
Preventing illness from exposure to extremes of temperature
Sunburn and skin cancer Lifting heavy weights Foot Injuries Lack of exercise and boredom
Preventing ill-health from seafaring work
General principles of promoting safety on board ship
The Health and Safety Committee Briefing for new tasks Work place assessment Provision of good medical care Seafarers' lifestyles

31 Anatomy and physiology
Note on anatomical terms and descriptions
The skeletal system
The muscular system
The circulatory system
The respiratory system
The digestive system
The urinary system
The nervous system
The endocrine system
The blood Blood and anaemia
The immune system Allergy

32 International Health Regulations
International Health Regulations (2005) Part I - Definitions, purpose and scope, principles and responsible authorities Part IV- Points of entry Part V- Public health measures Part VI - Health documents Part VII-Charges
Annex 1 - B. Core capacity requirements for designated airports, ports and ground crossings
Annex 2 - Descision instrument for the assessment and notification of events that may constitute a public health emergency of international concern Annex 3 - Model ship sanitation control exemption certificate/ship sanitation control certificate
Annex 4 - Technical requirements pertaining to conveyances and conveyance operators Annex 5 - Specific measures for vector-borne diseases Annex 6 - Vaccination, prophylaxis and related certificates Annex7- Requirements concerning vaccination or prophylaxis for specific diseases Annex 8- Model of maritime declaration of health

33 The ship's medicine chest
Basic rules for managing the medicine chest Anaphylaxis
Drug rash and other drug-related skin problems Controlled drugs Ships carrying dangerous goods
Specific categories of medicines
Fluids for intravenous infusion
List of recommended medicines and equipment Annex A: Forms for case reporting, referral, and evacuation
Ship master's report form
Ship's identity and navigational status form
Patient health status form
Primary physician's report form

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