Coffee Break Medical Training
Coffee break training is monthly, easy read during a cup of tea/coffee or a break during the day. It should never be stressful but should spark a conversation and more research between crew, along with adding knowledge to your medical tool kit.
Scenario
Your crew and guests, a family of 4, have just returned to your vessel one day ago from a half-day of inland fishing and crabbing in the Caribbean. The 15-year-old son walks past you on the way to the galley holding his hand on his forehead and states, “I have an awful headache”.
This is the family’s first week in the islands, but not their first time visiting. They are from an area where the weather is not as warm or humid.
You ask the young man, we will call him JJ, if he has been hydrating and with what type of fluids. He says yes, like most teenagers would, and when he responds you notice his cheeks appear flushed with a pink/red color. JJ continues to the cooler to get an ice water and rubs it on his head just above his eyes.
As he does this he states, “that feels so good, my eyes hurt”.
One of your crew checks his temperature with a non-contact forehead thermometer. The reading is 40.2 C (104.5F).
JJ tells you, “It hurts more when I move my eyes from side to side”. He also states he wants to lay down because he is tired. When asked, he states he does not have a cough, feel nauseas, or has any runny stool. He does have a bit of sunburn.
A little more history reveals that JJ was fishing in the mangroves on a dock during the day and had no shirt or shoes on. He said he was getting bit by mosquitos, no-see-ums, and big flies all day. He put on bug spray, but it was around sunset when he applied the spray.
The fever ends up lasting 4 days, fluctuating up and down from 37.5 C to 40.5 C but never completely goes to normal. His pain goes away with a cold cloth on his eyes, but the fever remains. A local clinic tests him for Covid (negative) and gives him antibiotics and Paracetamol. He also takes a commercial cold/flu medicine you have on the vessel, and it helps him sleep. After 4 days the fever and headache are both gone, and JJ is back to fishing. Blood work was done at the clinic but needs to be sent off island for results.
Discussion
A few things to discuss during this case is:
• Did anyone else get sick?
No. Even with close contact and eating the same food, family and crew never caught a fever. JJ is a healthy water-boy that knows his way around the mangroves. As with some boys it would take a pretty good illness to keep him from fishing. This one did just that.
• Did he become nauseas or show any other signs of increasing illness?
No. The severe eye pain made worse with moving side to side. Medical practitioners have pointed out, that should be a sign that can help direct you that something might be happening with his nervous system.
There are many directions you could go with the “clues” you are given. Malaria, Zika, Covid, the flu, food poisoning, ciguatera, Dengue (and more). When you get an opportunity, you should do a quick review of these on a web search. For today let’s focus on Dengue Fever.
What is dengue?
• Dengue is a viral infection spread by female mosquitoes that usually bite during the day. A more serious version of the disease, called dengue hemorrhagic fever, causes bleeding and can be deadly.
• Dengue is most common in the tropics and subtropics, such as Southeast Asia, Central and South America, and the Caribbean, and not limited to those areas.
• You can get dengue if you're bitten by an infected mosquito.
• Symptoms include fever, headache, and body aches.
• When a mosquito bites an infected person, it may pick up the virus and give it to the next person it bites.
• There's no medicine to kill the dengue virus.
• To know for sure a blood test specifically for Dengue must be done.
For 3 to 5 days, you may:
• Feel weak and tired.
• Have high fever and chills.
• Suffer with severe headaches.
• Have pain when you move your eyes.
• Suffer with severe aching pain in your back, and joints—this can be very painful. That’s why dengue was nicknamed “breakbone fever.”
• Show a rash on your face.
After you have these symptoms, you may feel better for a day, and then the fever and rash may come back, this time on your chest, back, arms, and face. You can get dengue more than one time.
If you're traveling to an area with dengue, you should take steps to prevent mosquito bites.
When a mosquito bites an infected person, it picks up the virus and gives it to the next person it bites.
What is dengue hemorrhagic fever?
Dengue hemorrhagic fever is a much more severe type of dengue. It mainly affects children younger than 10 in areas where dengue is common. These patients obviously need to be taken to a facility where they can render advanced treatments. Symptoms may include:
• Bleeding from your nose, mouth, rectum, and any puncture wounds
• Throwing up blood
• Blood in your stool or in urine
• Purple spots on your skin from bleeding under your skin
How might medical practitioners treat dengue?
Medical practitioners will sometimes have you take medicine, such as paracetamol, to lessen pain and lower your fever. They may also give you IV fluids (slowly, into your vein), especially if you have dengue hemorrhagic fever.
Consider not taking aspirin or ibuprofen because they may cause bleeding or make it worse. Make sure to assist the person with eating and drinking if they can tolerate it. Fluids by mouth are one of the most import treatments to assist with while the person is in our care.
For you and me, its easy to miss little signs and symptoms. Sometimes people don’t want to complain or put us out. Make sure you get a good baseline assessment on all signs and symptoms. A complete and repeated set of vital signs to watch for a trend along with a good, hands on with visual head to toe assessment, keeping the person comfortable. Write down everything you do, including times, because you may find certain changes that are relevant to the case.
This should tease you into doing a search online to get more information on Dengue Fever. Until next time, finish your coffee and get back to work safely.
P.S. – JJ is fine and tested positive for the antibody 2 weeks after having dengue. He still doesn’t wear a shirt or shoes.