Le tadalafil possède une affinité marquée pour la PDE5, mais épargne en grande partie les isoformes PDE1, PDE2 et PDE11, réduisant ainsi le risque d’effets extra-caverneux. L’action se traduit par une augmentation contrôlée de la circulation sanguine locale, indépendante des variations alimentaires. Sa pharmacocinétique repose sur une absorption digestive rapide, un métabolisme hépatique par CYP3A4 et une distribution tissulaire large. La biodisponibilité reste stable, et l’équilibre plasmatique est atteint en quelques jours lors d’administrations répétées. Les interactions cliniquement significatives surviennent avec les inhibiteurs puissants de CYP3A4 tels que le kétoconazole. Dans la littérature pharmacologique, acheter cialis 20 mg est souvent associé à des schémas d’utilisation basés sur la durée prolongée de son action.

Microsoft word - medical%20emergencies%20at%20sea[1].doc

North Shore Yacht Club
Medical Emergencies at Sea 101
March 2, 2011
• Basics: Assess the urgency of the situation (don’t be distracted by “dramatic” findings) • Use the best tools at hand: cell phone, VHF • An ounce of prevention … (holds triply true on a boat!) • Be appropriately prepared for the environment (i.e. Manhasset Bay versus Newport-Bermuda) • Visit a travel doc if you’re going somewhere exotic • Know your guests’ medical issues! • Educate your guests about basic emergency procedures Common Boating Emergencies
a. Cuts & scrapes
i. Prevent with gloves, booties, wetsuits, etc. ii. EDUCATE guests about winches, pinchpoints, windlass, engine, stove iii. Stop bleeding with direct pressure (not tourniquets) iv. Cleanse with water, remove foreign bodies if possible vi. Small cuts far from home can be closed with super glue; dirty cuts should be left b. Infection
iii. Antibiotics for real infections iv. If pus present, let it drain i. Prevent with sunscreen, hats, shirts! Even when snorkeling ii. Cook carefully. Treat tea, coffee with great respect! iii. If burnt, apply cool water until area cooled down iv. If blisters or non-intact skin, apply antibiotic ointment & dressing 2. Fractures
a. Big problem on a boat! b. Legs: gently straighten limb, and immobilize with splint c. Arms: sling usually OK 3. Intestines
a. Seasickness
i. Avoid fatty, greasy foods & large portions ii. Identify what works for you BEFORE your trip iii. Medications vs devices vs natural remedies (ginger) iv. Take the helm b. Dehydration (from vomiting or diarrhea)
i. Drink lots of water, soda, tea, coffee, anything! ii. Take antibiotics for traveler’s diarrhea (1 dose of Cipro, Levaquin) 4. Exposure/Immersion
a. Hypothermia is very common, even on deck
i. Symptoms: irritability, memory loss, unresponsive ii. Occurs very quickly in warm or cool water; get the man overboard back on iii. Warm with blankets, another body, heater if available, hot drinks if conscious b. Drowning
ii. Learn CPR before you need it (frequent courses nearby, e.g. St. Francis Hospital) iii. Dial 911, then 2 breaths/30 compressions (@ 100 per min), repeat 5. Head Injury (i.e. head vs boom)
a. Avoid sailing straight downwind! b. Assess consciousness; ABCs if needed c. Mild: confusion, memory loss, headache, nausea or vomiting, blurred vision, slurred Dan’s Bare-Minimum Medical Kit
a. Ibuprofen (and plenty of it!) – safer and more effective than acetominophen b. Dramamine/Bonine/Meclizine c. Antibiotic: levaquin or cipro (may be over-the-counter in foreign lands) d. Antibiotic cream/ointment: mupirocin (Bactroban) e. Anti-diarrheal: Pepto-bismol, immodium (if absolutely necessary) 2. Goodies
a. Tape b. Superglue c. Gauze (4x4, 2x2) d. Ace wrap e. Band-aids a. Swiss army knife with scissors b. Tweezers

Source: http://www.nsyc.net/bosun/MedicalEmergenciesAtSea.pdf