ANNEX I - GOV.UK
215Anatomy and physiologyTo provide adequate medical care on board ship there is noneed to have a detailed knowledge of anatomy (structure ofthe body) or of physiology (function of bodily systems).Nevertheless the information provided in this Annex couldbe useful when examining a patient or obtaining and actingon radio medical advice.The principal bones of the skeleton and the main musclesof the body are illustrated in Figures I.1 and I.2. The positionof the organs in the chest and abdomen is depicted in Plates 14and 15.The bone structureThe skeleton, which consists of bones and cartilages, providesa rigid framework. The separate bones and cartilages are heldtogether firmly at the joints by strong bands of connectivetissue (the ligaments). Each bone is enveloped in a very toughadherent sheath of fibrous tissue. Between the sheath andthe bone surface is a layer of bone-forming cells which canproduce new bone in the event of a fracture.The shaft of a typical long bone has a thick wall of densebone which forms a hollow cylinder enclosing a central canalcontaining bone marrow. At each end the shaft is expandedto make the joint surface. These surfaces are covered by asmooth layer of cartilage to permit movements withoutcausing friction.ANNEX IAnatomy and physiologyBone structureVoluntary musclesInvoluntary musclesCirculatory systemBreathing systemDigestive systemUrinary systemWITHDRAWNPUBLICATIONVoluntary musclesThese form the bulk of the fleshy parts of the body. They arefixed to the bones by blending with the sheaths of fibroustissue surrounding the bones. Some are attached directly to awide area of bone surface but others taper to form a strongcord (tendon or leader) which is attached at a specific placeon a bone. Muscles, and especially those of the limbs, arearranged in two opposing groups. Contraction of one groupin response to an impulse through the nerve supply must beaccompanied by simultaneous relaxation of the opposinggroup, or movement will not take place. These movementsare under conscious control.Involuntary musclesThese are found in the stomach and intestines, in the heartand blood vessels, and also in other internal organs of thebody. They continue to work throughout life as part ofnatural body function outside the control of personal will.Nervous systemSkinANNEX IIAnatomical drawingsThe skeletonMain voluntary musclesOrgans of chest andabdomenAnatomy and physiology – Anatomical drawingsANNEXESANNEX I
216THE SHIP CAPTAIN’S MEDICAL GUIDECirculatory systemLegsBloodArmsThe body contains about 5 litres of blood which consistsbasically of four constituents: plasma; red cells; whitecells; and platelet cells.The plasma is the liquid component of the bloodwhich circulates to all the tissue cells throughout thebody. It distributes food, water, salts and heat andcollects waste products which are subsequently excreted.The red cells predominate and give the blood itscolour. This colour is derived from a complex ironcompound (haemoglobin) which is the main oxygencarrier.The white cells give protection against infection byattacking and killing bacteria and also by producingsubstances which are necessary for building up resistanceto further infections.The main purpose of platelets is to assist in the bloodclotting ntestinesTrunkThe heart and blood vesselsThe heart is a thick-walled muscular pump about the sizeof a clenched fist. It is divided in the mid line into two sideswhich do not communicate. Each side has an upper andlower chamber which communicate through a main heartvalve. The separate chambers are each served by a majorblood vessel that either brings blood to the chamber orcarries it away. See Plate 15.The right side receives venous blood which, havingbeen circulated around the body, has given up its oxygenand collected carbon dioxide. This blood is pumpedthrough the lungs where it is replenished with oxygenand discards the carbon dioxide. As purified blood, itreturns to the left side to be pumped through thearteries to all parts of the body.The blood vessels form a closed system of tubes. Thearteries, which have to take the full force of the pumpingpressure, have thick walls containing muscle fibres andelastic tissue. Each heart beat widens the bore of thearteries to accommodate the surge of blood. Betweenbeats the bore is returned to normal by the action of themuscle fibres and elastic tissue. Where an artery runsclose to the body surface, the changing pressures can befelt as a pulse.The arteries penetrate to all parts of the body,dividing and sub-dividing until they narrow to form verythin-walled vessels (capillaries). The capillaries then joinwith the venous network which returns the blood to theheart (Figure I.2). The size of veins increases until theheart is reached.The capillary system is vital to the life of all tissues. Thethin capillary vessel wall allows nutrients, oxygen, heatand beneficial chemical substance to enter the cells and,most important, waste products to be passed out into theblood.LegsFigure I.1 The heart and the variouscirculations, diagrammaticArteryCapillarynetworkVeinFigure I.2 Capillaries
Annex I ANATOMY AND PHYSIOLOGYLarynxVein Bronchiole ArteryVein Capillary ArterynetworkElasticfibresRight mainbronchusLeft mainbronchusAlveoliAlveolarcanalABCFigure I.3 Lungs, bronchi, and alveoliWITHDRAWNPUBLICATIONBreathing systemEvery time a breath is taken in, the air (20% oxygen) passes through the nose or mouth and thenpast the larynx or voice box into the windpipe (trachea) which is about 12.5 cm long. At its lowerend the windpipe divides into two main tubes called bronchi (Figure I.3).The main air passage in each lung (the bronchus) divides into successively smaller brancheswhich carry inhaled air to all parts of the lung. Each small branch terminates by forming acluster of very tiny air sacs (the alveoli). A fine network of blood vessels covers the surface ofevery air sac thereby permitting gas exchange by diffusion. Oxygen from the inspired airpasses through the thin tissues to combine with the haemoglobin of the red blood cells.Waste gases, mainly carbon-dioxide, pass from blood into the air sacs and are expelled onbreathing out.Haemoglobin Oxygen Oxyhaemoglobin(purple red colour)(bright red colour of normal blood)Whenever the blood is insufficiently oxygenated, as in pneumonia, the purple red hue of theblood shows as a blue tinge of the lips.Each lung is covered by a lubricated lining called the pleura. The inner side of the chest wallis also covered by a similar lining. These two layers of pleura are in contact and slide smoothlyover one another during breathing.The act of breathing is mainly due to the diaphragm moving up and down. The diaphragmis a large dome-shaped muscle which separates the chest from the abdominal cavity. Whenthe diaphragm muscle contracts, its dome becomes flattened and draws down the lungs,causing air to enter them; when it relaxes the lungs become smaller and the air in them isexpelled. The muscles of the abdomen also help in breathing. When they tighten up, theypress the abdominal contents up against the diaphragm and help in expelling air from thelungs; when they relax, they assist the diaphragm in drawing down the lungs as breathing intakes place.The normal rate of breathing at rest is 16–18 times a minute. This rate increasesconsiderably with exertion and also with certain diseases, especially those affecting the heartand lungs.217
218THE SHIP CAPTAIN’S MEDICAL GUIDEDigestive systemThe abdomen is a cavity shut off from the chest by the diaphragm. The cavity is lined by a sheathof membrane (the peritoneum) which also enfolds some of the abdominal organs. The sheathsecretes fluid which keeps the abdominal contents moist and prevents friction.The digestive tractThis is a passage consisting of the gullet (oesophagus), the stomach, the small intestine, thelarge intestine, the rectum and the anus.The gullet is a straight muscular tube which joins the throat to the stomach. It passes downthrough the back of the chest cavity and goes through an opening in the diaphragm to connectwith the upper part of the stomach.The stomach is a J shaped pouch. It enlarges when food or liquid is consumed. The lower partof the stomach is narrow where it joins with the first part (duodenum) of the small intestine.The small intestine is a narrow-bore coiled tube, roughly 7.5 metres long, which occupiesmost of the central part of the abdominal cavity. The internal surface of the wall bears a largenumber of very small folds which project inwards to increase the surface area in contact withthe contents of the intestine. The small intestine joins with the large intestine in the right lowerquarter of the abdomen.The large intestine is a wide-bore tube, roughly 1.5 metres long, which arches upwards andacross the abdominal cavity before descending the left side to join with the rectum.The rectum is roughly 150 mm long and is continuous at its lower end with the very short analcanal which opens to the exterior.WITHDRAWNPUBLICATIONThe digestive processDigestion is the physical and chemical breakdown of food into useful products which are thenabsorbed by the capillaries of the blood vessels serving the gut. The unwanted residue of foodis excreted as faeces.The digestive tract walls contain involuntary muscle which by contractions moves thecontents through the entire length until they reach the rectum where they are stored as faecesprior to evacuation. At certain places such as the entrance and exit to the stomach and at theanus, circular bands of muscle capable of constriction (sphincters) act as valves to shut off theflow.The physical breakdown of food is accomplished by chewing, by the churning actions of thegut and by the addition of special digestive juices to the food. This begins in the mouth whenfood is mixed with saliva which contains enzymes. In the stomach, acid gastric juice is secretedby the stomach walls and acts on the food which may be retained there for several hours beforepassing through the duodenum. Small ducts from the bile system of the liver and also from thepancreas open into the duodenum. These ducts provide juices which are partly designed toneutralise the acid from the stomach juice and thus allow the enzymes secreted by theduodenal walls to act more efficiently. The churning of the gut then ensures a thorough mixingof food and digestive juices throughout the length of the small intestine where most of thechemical breakdown takes place. The main functions of the large intestine are to re-absorbwater from the food residue and to reduce the bulk of the faeces.The liverThe abdominal veins drain into the liver and carry to it the useful products which have beenabsorbed during the digestive process. One of the main liver functions is to act as a chemicalfactory which processes these products into substances necessary for nutrition.
Annex I ANATOMY AND PHYSIOLOGYUrinary systemThe kidneys are located at the back of the upper part of the abdominal cavity, one on each sideof the spine (see Plate 14). They are embedded in fat to cushion them from injury.The main kidney function is to remove water and certain harmful waste products from theblood and, by this filtering process, to form urine. They control total body water and theconcentration of various chemical substances in the blood. The kidneys also play an importantpart in maintaining a steady level of blood pressure.The urine is carried downward from the kidneys to the urinary bladder by tubes of smallcalibre (the ureters); one tube for each kidney. The urinary bladder is a muscular bag situated inthe front part of the cavity formed by the pelvic bones. The bladder acts as a reservoir whereurine collects until it is expelled by voluntary muscular contractions through a tube (theurethra) which leaves from the bladder base.The male urethra measures 18 to 20 cm from the bladder to the external opening at the endof the penis. A knowledge of this length is important when passing a catheter. The femaleurethra is much shorter, being about 4 cm in length. It runs embedded in the upper vaginal wallto the external opening just above the vaginal orifice.Nervous systemWITHDRAWNPUBLICATIONCerebro-spinal nervous systemThis consists of the brain, spinal cord and the associated nerves. The brain is in the cavity of theskull. It is the co-ordinating centre for the nervous system, processing incoming informationfrom nerves concerned with sight, smell, taste, hearing, sensation etc. and controlling variousparts of the body, particularly muscles by way of out going (motor nerves). Higher functionsinclude intellect, memory, personality etc.The spinal cord emerges from the base of the brain and leaves the skull into the bonyvertebral canal. It is protected by vertebrae throughout its length, and nerves emerge atregular intervals. These nerves control muscles and transmit sensation back through the spinalcolumn to the brain.Sympathetic nervous systemThis is a fine network of nerves not under direct voluntary control influencing the function ofvarious organs, especially gut, bladder, blood vessels and heart.SkinThis protects and covers the body. It consists of two layers. The outer layer is hard and containsno blood vessels or nerves. This outer layer protects the inner layer, where there are sensitivenerve endings numerous sweat glands and the roots of the hair.Sweat consists of water, salt and some impurities from the blood. The evaporation of thesweat cools the body, and helps to regulate its temperature.219
220THE SHIP CAPTAIN’S MEDICAL GUIDEANNEX IIAnatomical drawingsFRONT VIEW OF SKELETONCranium (skull)FrontalOrbit (eye socket)CraniumMandible (lower jaw)Orbital fossaMaxillaClavicle (collar bone)ClavicleHead of humerusarticulating with scapula(shoulder joint)MandibleSternumHumerus (upper arm bone)Ulna (inner bone offorearm)HumerusRadius (outer bone offorearm)10 ribsjoinedto sternumby costalcartilageplus2 floatingribs notjoined tosternumWITHDRAWNPUBLICATIONCarpal bones (small handbones of wrist joint)Metacarpal bones (longbones of the hand)Phalanges (bones of thethumb and fingers)RadiusIliumUlnaSternum (breast bone)PubisHipboneRibsCostal cartilages (non-bonyattachments of ribs to thebreast bone)IschiumCarpalsMetacarpalsFloating ribs (not attachedto the breast bone)Ilium (bone of the pelvis)PhalangesFemurIschium (bony partunderlying the buttocks)Pubis (joining the twopelvis bones)PatellaHead and neck of femurforming part of hip jointFemur (thigh bone)FibulaPatella (knee cap)Tibia (shin bone)FibulaTibiaTarsal bones (small bonesof the foot)Metatarsal bones (longbones of the foot)Phalanges (bones of thetoes)Figure I.1 The skeleton (front)TarsalsMetatarsalsPhalanges
Annex II ANATOMICAL DRAWINGSBACK VIEW OF SKELETONincludingParietal and occipitalbones (part of cranium)Parietal boneOccipital boneVertebral column (spinalcolumn)Scapula (shoulder-blade)Sacrum (base of the spine)Coccyx (small bones at thebase of the spine – tailbone)ScapulaOs calcis (the iusSacrumUlnaCoccyxFemurFibulaTibiaOs calcisFigure I.2 The skeleton (rear)221
222THE SHIP CAPTAIN’S MEDICAL GUIDEMasseterStrenothyroidSternocleidomastoidFront IONLine of internaland ctusabdominisFlexorsfor fingers,hand andwristQuadricepsTibialisand peronealmusclesAnkleand footextensorsFigure II.3 Main voluntary muscles (front)
Annex II ANATOMICAL sLatissimus dorsiGluteus mediusExtensorsfor wrist,hand andfingersGluteus maximusIlliotibial lcaneous(achillies) tendonFigure II.4 Main voluntary muscles (rear)223
224THE SHIP CAPTAIN’S MEDICAL GUIDELarynxGulletThyroid glandWindpipe1212WITHDRAWNPUBLICATION33Left lungRight lung44Heart567Liver8567Spleen899StomachGall bladder1010Large intestineSmallintestineCaecumAppendixBladderPlate 13 Organs of chest and abdomen (front)
225Annex II ANATOMICAL DRAWINGS1122334455WITHDRAWNPUBLICATIONLeft lungSpleen667788Right lung99101011111212LiverLeft kidneyRight kidneyLarge intestineUreterLargeintestineBladderPlate 14 Organs of chest and abdomen (rear)
WITHDRAWNPUBLICATION
ABC status 76AbdomenExamination 142Organs 224–5Abdominal emergencies 142–3Abdominal pain or discomfortAppendicitis 143–4Blast injury 40Bleeding, internal 22Chemicals, ingestion 46–7Cholera 100Colicky, causes 144–5Cyanide poisoning 48Enteric fever 102Glandular fever 103Minor abdominal conditions 137Pelvic inflammatory disease 123Peritonitis 150Severe 138–9Spasmodic 137Yellow fever 115Abdominal tenderness 139, 141Abortion 140–1Abrasions 69Abscesses 172–3Aching, of body generallyMalaria 105–7Poliomyelitis 110Acquired immuno deficiencysyndrome (AIDS) 124Acute gastroenteritis 146Acute red eye 163–4Adhesive skin closures 71Adrenaline 181Aedes mosquitoes 101Alcohol 46abuse 64, 179–80AllergyLesser reactions 181Major reaction 181Alveoli 217Amitriptylline 46Ammonia vapour 48Amoebic dysentery 59, 147Anaemia 182Anal discomfortfissure 143itching (pruritus) 143Anatomy 215–19Drawings 220–5Angina pectoris 128, 130–1Animal bites 170–1Ankle fracture 31Anorexia nervosa 193Ant sting 172Anthrax 98Antibiotic treatmentBarber’s rash (sycosis barbae) 174Boils, hand 190Burns 82Chest injuries 39Diphtheria 101Eye ointment 78–80Face/mouth wounds 82Hand infection 173Impetigo 176Internal injuries 74Kneecap fracture 30–1Lymphangitis 186Open fracture, fingers 26Paronychia 174Rat bites 170Wounds 73Antihistamines, side effects 181,184Antiseptic 91Anusol 143, 147Anxiety 159Appendicitis 138–9, 142, 173–4Pain shifting 152Artery 216Artificial respirationAllergic reactions 181Coronary thrombosis 129Inhaled poisons 46Lung (blast) injury 40Overdose 47Suffocation 18Survivors, after hypothermia 202Unconscious patient 15–16Asphyxia 18AspirinCoronary thrombosis 129Overdose 47Urticaria 178Astemizole 178Allergic reaction 181Asthma 54, 133–4, 181Astringents 46Athlete’s foot 175A.V.P.U. score 76–7Blast injuries 39–40Abdomen 40Head 39Lungs 39–40Bleaching solutions 48BleedingExternal 20–1Internal 22Abdomen (blast injuries) 40Fractures 27High bone shaft fracture 30Pelvis fracture 36Severe 14Wound 71Bleeding peptic ulcers 151Blisters 83Anthrax 98Chickenpox (varicella) 99Blood 216Coughing up 22Transfusion 22Vomiting 22Blood pressure, high 132Blood vessels 216Boils 172–3Hands/fingers 190Bone structure 215Boredom 94Bovine spongiform encephalopathy(BSE) 95Bowelmovement 58sounds 142–3Brain 219Compression 64Concussion 64Breathing difficulties 61Breathing systems 217Bronchi 217Bronchitis 46, 60Acute 134–5Chronic 135Measles 107Buboes 109, 119–20, 129Burial at sea 207BurnsChemical 17Eye 80Classification 82Electrical 17Fluid loss 82Heat 17Rule of nines 82–3Special 83Treatment 82–3WITHDRAWNPUBLICATIONBabyDeformity or death 200Not breathing after delivery 200Presentation, births 200Bacillary dysentery 147Acute 59Backache 94, 168–9Dengue fever 101Painful period 193Plague 109Poliomyelitis 114Yellow fever 115Bacteria 95Bacterial vaginosis 122–3Balanitis 117Balanoposthitis 118Bandages 7–11Barber’s rash 174BedBaths 56Feeding patients 56Sores 57Bee sting 172Bell’s palsy 160Benzoic acid 175–6Betamethasone 191–2Biliary colic 130–1, 138–9, 145Bites 69Animal 170–1Snake 170–7Black eye 79Bladder/kidney inflammation 155–6Calamine lotion 99, 101, 107, 177Shingles (herpes zoster) 178Cap 195Capillaries 216Carbolic acid 48Carbon dioxide poisoning 46Carbon monoxide poisoning 46, 48Carbonic acid gas 48Carbuncles 172–3Caries 165Carrier 96Index227
228THE SHIP CAPTAIN’S MEDICAL GUIDECatering staff, personal hygiene 90Catheterisation, male 156–8Cellulitis 99, 172–3Centipedes 172Cerebro-spinal fluid, leakage 75Chalazion 163Chancre 120Chancroid 117, 119–20Chaps 175Charcoal, oral 47Chemical splashes 17Chest compression 16Allergic reaction 181Baby not breathing after delivery 200Coronary thrombosis 129Chest injuries 38–9Chest organs 224–5Chest pain 128, 135Associated signs 130–1Chickenpox 99Chilblains 175Child inside womb 197Childbirth 197–200Chlamydia 117Chlamydial lymphogranuloma 117, 121Chlorhexidine gluconate 20%(HIBISCRUB) 189Chlorinated lime 86–7Chlorine 45Compound 86Chloroquine 106–7Chlorpromazine 158–9Delirium tremens 180Choking 18Cholecystitis 130–1, 145–6Cholera 59, 88, 100, 146Chostochondritis 136Cimetidine 150Ciprofloxacin 102After delivery 199Bacillary dysentery 147Bronchitis 135Cholecystitis 146Genital ulcers 119Otitis media 162Urethritis 118Circulatory collapse 19–20Circulatory system 216Cleanliness 69On board ships 90Clove oil 165–6Codeine phosphateBackache 168Boil in the ear 162Coronary thrombosis 129Gout 168–9Head injury 77Meningitis 108Twisted testicle 154Urticaria 178Coil 195Cold in the chest 134Colds 95Collapsed lung 137Collar bone fracture 28Common cold 182Virus 85Communicability period 96Communicable diseases 95–115Infectious agents 95Management, general rules 97Symptoms and signs 96Terms used 96Transmission modes 95–6Composite temperature 94Compression of brain 75Compression test, pelvis fracture 36Concussion 77Condom 126, 195Conjunctivitis 160, 163–4Consciousness level 74Constipation 204Contact 96Contraception 195Contraceptive pill 195Convulsions 19, 48Head injury 76Corneal abrasion 79Coronary arteries 128Coronary thrombosis 128–31Crepitus 191Cresol 48Creutzfeld Jacob disease 95Crush injuries 25Hand 30Crutch bandage 10Curly weed rash 192Cyanide 48Cystitis 140–1, 155–6Hernia rupture 148High blood pressure 132Paroxysmal tachycardia 129Prickly heat 177Rectal 76Snake bites 170Diet, balanced see also Food 89Diclofenac 133, 191Rheumatic fever 169Digestion 218Digestive system 218Diphtheria 101DiseasesCauses and prevention 85Communicable 95–115Disinfectant poisoning 48Disinfection at the end of illness 91–2Disinfestation 91Dislocations 37, 84Doctor(s)Communication 214Ship-to-ship transfer 213Dogger Bank itch 192Doxycycline 100, 110, 114Chancroid 120Chlamydial lymphogranuloma 121Genital ulcers 119Granuloma inguinale 122Pelvic inflammatory disease 123Sinusitis 165Syphilis 121Twisted testicle 154Urethritis 118Vaginal discharge 123Dressings 7Drug abuse 183–4Drunkenness 179Duodenal ulcer 150–1Perforated 144Duodenum 218Dying, care of 205Dysentery 90WITHDRAWNPUBLICATIONDapsone 106DeathCause of 206Disposal of the body 207Mistaken 205Procedure after 206–7Signs 205Dehydration 61–2Alcoholic 179–80Cholera 100Survivors 204Delirium tremens 180Deltoid muscle, intramuscularinjection 66Dengue fever 101Dental abscess 160Dental injuries 81–2Dental pain 165Deodorant 91Depression 158–9Dermatitis 175, 181Dhobie itch 175–6Diabetes mellitus 118, 173Treatment 182–3Diabetic coma 64, 182–3Diaphragm 126, 217Diarrhoea 61, 138, 140, 142, 146Acute gastroenteritis 146Anthrax 98Cholera 100Diazepam 19, 46Angina pectoris 128Anxiety without depression 159Burns 82Ear(s)Boil 162Examination 161Foreign bodies 81InfectionMiddle 162–3Outer 161–2Internal 81Parts 161Wax 161Ectopic pregnancy 123, 140–1, 145,194Eczema 181Elbow fractures 28Electrocution 17Enteric fever 95, 102, 146Epilepsy 64Fits 19Ergometrine 194, 198–9Erysipelas 99Erythromycin 114After delivery 199Appendicitis 144Bronchitis 195
INDEXChlamydial lymphogranuloma 121Otitis media 162Sinusitis 165Syphilis 121Exercise 94Eye 163Anatomy 78Bandage 11Chemical contact 47Deep inflammation 164Diagram 78Examination 78–9Fire extinguisher powder, damage 17Injuries 78–81Arc eyes (Welder’s flash) 80Chemical burns 80Corneal abrasions 79Eyeball wounds 80Eyelid wounds 80Foreign bodies 79Facial paralysis 100FaecesExamination 58–9Abnormalities 58–9Certain diseases’ effects 59Testing 195Fainting 64Fansidar 106–7Female sexual organs 193Femidom 195Fenol oils 48Fever 53Anthrax 98Chickenpox (varicella) 99Malaria 106Meningitis 107Scarlet fever 112Fibrositis 169–70Filariasis 95FingerDislocation 84Fractures 29Infections 189–90First aidGeneral assessment 6General principles 5Kit 14Priorities 5Fish hook, removal 192Fish poisoning (erysipeloid) skindisease 192Fishermen’s conjunctivitis 191Fishermen’s tenosynovitis 191Fits, head injury 76see also ConvulsionsFlies 85Fluconazole 118, 123Fluid balance 61–2Fluid retention 187Fluids by rectum 22, 62, 150Fluorescein 80FoodBacteria 89–90Canned 89Contamination 89Fruit 89Poisoning 146Vegetables 89FootBandage 10Fractures 32Forearm fractures 29Fractures 26–36Circulation 27Closed 26Immobilisation 27Open 26Stress 26TreatmentGeneral 27Principles 26–7Freon 49Frostbite 94, 203FrusemideCoronary thrombosis 129Heart disease, oedema 187Fungi 95229Pain relief 77Serious 75–6Signs 75–6Head and scalp bandage 11HeadacheCellulitis 173Hangover 180Head injuries 76Sea sickness 188Tension 164Heart 216, 224Pain 128Heartburn 130–1, 150Heat illness, prevention 93–4Heel bone fracture 31Heimlich sign (choking) 18Helicopters 211–13Hematoma scalp 77Hepatitis 97, 104B 117HerniaInguinal 148Rupture 148Strangulation 148–9, 155Herpes zoster see Shingles 178High-test calcium hypochlorite 87Hip bandage 10Hookworm 95Hornet sting 172Human immunodeficiency virus (HIV)117, 124–5Hydrocoela 154Hydrocortisone (1%) ointment 175, 192Hydrogen 46Hyoscine hydrobromide 188Hyperbaric oxygen therapy 48Hyperpyrexia 52, 184–5Hypertension 132Hypothermia 17, 53, 94, 201–2Causes 201Diagnosis 201–2Treatment 202WITHDRAWNPUBLICATIONGallstone 138–9Colic 145Gastric ulcer 150Genitalherpes 117, 120itching 195ulcers 119warts 117, 123Germaliods 147German measles 103Gingivitis 160, 165Glandular fever 103, 167, 180Glasgow Coma Scale 74Glyceryl trinitrate 128Gonorrhoea 85, 95, 117, 122Complication 153Gout 168–9Gouty arthritis 168–9Grand mal 19Granuloma inguinale 117, 122Grazes 69Guardia 95Guedel airway 63, 65, 83Gullet 218, 224Gum(s) ulcers 166Haddock rash 191Haematoma 22Haemiplegia 160Haemoglobin 216Oxygen carrying capacity 217Haemorrhoids see also Piles 58, 143,147–8Bleeding 148HandCuts 191Infections 173, 189–90Tendons 189Hand bones, fractures 29Hangover 180Hay fever 184Head injuries 37Assessment of the patient 74–5Communication 76–7Minor 77Ibuprofen 191Immersion foot 203Immunisation 98Enteric fever-typhoid 102Poliomyelitis 110Tetanus 112Impetigo 176Incontinence 58Incubation period 96Indigestion 137Acute 138–9Infectious mononucleosissee Communicable diseases 103Influenza 95, 104Inguinal hernia 118Inhaled poisons 45–6InjectionsFilling a syringe 66–7Intramuscular 66Subcutaneous 66Insecticides 91Insulin 183coma 182–3Internal injuries 74
230THE SHIP CAPTAIN’S MEDICAL GUIDEIntestinal colic 138–9, 149Intestinal obstruction 140–1,149Intestine 218, 224–5Intra-uterine (coil) device 123Involuntary muscles 215Isolation 92Period 46Jarisch-Herxheimer reaction 119,121Jaundice 149Gallstone colic 145Glandular fever 103Hepatitis 104Yellow fever 115Jaw fracture 32, 81–2Muscle spasm 92Jellyfish 171Jumbo wrist 191Kidney(s) 219, 225Stones 138–9KneecapBandage 10Fracture 30–1Kuru 95Malaria 85, 95, 146Areas 105Guidelines 106Mosquito bites, avoidance 105Prevention 105–6Treatment 106–7Malnutrition 204Maloprim 106Mastoid cells, infection 163Mattress suture 72–3Measles 95, 107, 134Med Alert Bracelet 181Medivac service by helicopter 211–13Mefloquine 106–7Melaena 58Meningitis 107–8Headache 163Knee straightening test 108Neck bending test 108Meningococcal sepsis 97Menstrual cycle 193Mental illness 158–9Serious 62–3Metacarpal bones 29Metazoa 95Methyl chloride 48–9MetronidazoleAmoebic dysentery 147Appendicitis 144Gingivitis 166Pelvic inflammatory infection 123Peritonitis 150Vaginal discharge 123, 195Miconazole cream 176Microbes (germs) 85Migraine 164Miscarriage 140–1Inevitable 194Threatened 194Morning-after pill 195Morning sickness 193Morphine 20, 22Anxiety relief 205Backache 168Biliary colic 145Bleeding peptic ulcers 151ContraindicationsChest injury 24, 38, 40Head injury 24, 77Coronary thrombosis 129Crush Injuries, hand 30Eye, chemical contact 47Fractures 27Gallstone colic 145Internal bleeding 22Internal injuries 74Pelvis fracture 36Perforated ulcer 152Renal colic 155Retention of urine 156Shoulder dislocation 84Strangulated hernia 148Thigh bone shaft fracture 30Vaginal bleeding 194MouthCare 36Injuries 81–2Ulcers 160Mumps 109, 118Complications 153Muscular rheumatism 130–1, 136,168Nail bed inflammation 174Nail fold infections 190Neck injuries 35Neil Robertson stretcher 33, 42–4Neomycin 191–2Nerves 159Nervous system 219Nettle rash 178, 181Neuralgia 159Nitrazepam 46Non-freezing cold injury 203Nose bleeding 132Nose injuriesForeign bodies 81Inside 81Nurses 51NursingCare of the injured 52General 51–2WITHDRAWNPUBLICATIONLabourAfter delivery 199Birth 198–9Onset 194, 198Preparations 198Problems during 200Stages 197Subsequent management 179Lacerations 69Laerdal Pocket Mask 46Laryngitis 167Laxative, after delivery 199Legionnaires’ disease 85Legs, fractures 32LiceHead 177Pubic 177Lignocaine hydrochloride 71Fish hook removal 192Gel 147Injection, pattern 171Pulp space infection 190Sea urchins 172Lindane (1%) cream 124, 177Liver 218, 224Local anaesthetic 71Lumbago 94Lungs 217Lymph nodeLocation 186Swelling 122Lymphadenitis 186–7Lymphangitis 185–6Septic finger 190Lymphatic inflammation 185–6Lymphoid fever 90Madness 158Magnesium trisilicate compound137, 146, 150OedemaCaused by heart disease 187Generalised 187Localised 187Oesophagus 218Oil, contamination with 204Onchcerciasis (river blindness) 95Orchitis 109Osteo-arthritis 170Otitis media 161–3Overdoses 46–7OxygenCoronary thrombosis 129Haemoglobin carrying capacity 217Pleural effusion 136Pneumothorax 137Requirements, head injury 37Suffocation 18Oxyhaemoglobin 217Palmar space infection 190Panda eyes 75ParacetamolAbscesses 173Anal fissure 143Boils 162, 173Bronchitis 135Carbuncles 173Cellulitis 99Chostochondritis 136Common cold 182Dengue fever 101Fibrositis 169–70Glandular fever 103Hangover 180Head injuries 77Influenza 104Measles 107Minor abdominal conditions 137Mumps 181Overdose 47Painful periods 193Pleurodynia 136
INDEXParadoxical chest movements 39Pa
the bone surface is a layer of bone-forming cells which can produce new bone in the event of a fracture. The shaft of a typical long bone has a thick wall of dense bone which forms a hollow cylinder enclosing a central canal containing bone marrow. At each end the shaft is expanded t
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Annex 5: Response ECCO Annex 6: Response Gabor Annex 7: Response M&S Annex 8: Response PUMA Annex 9: Response Van Lier Annex 10: Response Primark Annex 11: Response MVO Nederland (CSR Netherlands) Annex 12: Response Leather Working Group . Child labour in the production of brand name leather shoes. in India." .
ICAO Annex 1 – Amdt.172 Annex 6 – Amdt.38 PANS-TRG – Amdt. 3 Doc 10011 02/2014 ICAO amendments to Annex 1, Annex 6 and PANS-TRG (Doc 9868) to a) Meet the UPRT requirements for an MPL, contained in Annex 1 b) Provide UPRT recommendations for a CPL(A), contained in Annex 1 c) Meet the requirements for type-rating, contained
Bills of Exchange Annex Equities Annex Gilts Annex Italian Annex Japanese Annex ** RITS Annex Abu Dhabi X X X X X X Australia X X X X X X X X Bahamas X X X X X X Bahrain X X X X X X Bermuda X X X X X X British Virgin Islands X X X X X X Cayman Islands X X X X X X . Section 730 of the UK Taxes Act
Annex 6 Operation of Aircraft Annex 7 Aircraft Nationality and Registration Marks Annex 8 Airworthiness of Aircraft Annex 9 Facilitation Annex 10 Aeronautical Telecommunications Annex 11 Air Traffic Services . Therefore, ICAO has implemented the
EU GMP Guide-Annex 15 Qualification & Validation draft released In February 2014, a draft of the revised Annex 15 was released by the European Commission (EC) for public comment. The draft version is based on an EMA Concept Paper, published in November 2012 which outlined various reasons for the revision of Annex 15.File Size: 553KBPage Count: 17Explore furtherEU GMP Annex 15: Qualification and Validation - ECA Acad www.gmp-compliance.orgEU GMP Annex 15 Revisions: Improving Qualification and .www.cleanroomtechnology.c GUIDELINES ON VALIDATION APPENDIX 6 VALIDATION O www.who.intGuideline on Process Validationwww.ema.europa.euEudraLex - Volume 4 - Good Manufacturing Practice (GMP .ec.europa.euRecommended to you b
According to NB-MED/2.2/Rec4. Conformity Assessment Procedures Annex III EC type-examination Annex IV EC verification Annex V production quality assurance Annex VI product quality assurance Annex VII EC declaration of conformity Annex II full quality assurance system xxxx Hardly
Annex L : API Standard 650 Storage Tank Data Sheet Annex M : Requirements for Tanks Operating at Elevated Temperatures Annex P : Allowable External Loads on Tank Shell Openings Annex S : Austenitic Stainless Steel Storage Tanks Annex V : Design of Storage Tanks for External Pressure Hossein Sadeghi WELDED TANKS FOR OIL STORAGE (Rev. 0) 12 STANDARD INTRODUCTION. Hossein Sadeghi WELDED TANKS FOR .
