ClipperTelemed+ and PRAXES Medical Group Medical Director, Dr John Ross, recalls a medical incident at sea that was dealt with swiftly and without a vessel diversion
This story began when a 61 year-old captain of a vessel, located far from shore, called the on-board medic at approximately 6 am. The captain was worried that he had experienced a stroke during the night while he was sleeping. While brushing his teeth, he noticed in the mirror that he had a right facial droop and was drooling on that side. Additionally, he could not blink his right eye and he felt slightly nauseated and light-headed.
The medic met him in the small medical room on board. She examined him and confirmed his findings. An immediate call was made to begin preparations to have the captain transported off the vessel. One of the crew was tasked with the logistics of getting the captain ashore to a medical facility that could manage his stroke. They were at sea, many hundreds of nautical miles from an appropriately staffed hospital. The medic called Praxes Emergency Specialists for advice while arrangements were being made.
Following a quick review by the medic over satellite phone, the doctor asked to get some more information. Emergency medicine can be tricky because the doctor often has to start treating problems due to patient instability while at the same time trying to gather more information.
The doctor always needs to consider the worst-case-scenario and work backwards.
A ‘first principle’ of emergency diagnosis is to come up with a most likely diagnosis, but always be thinking about what else might be the cause. It did sound like a possible stroke, but on further questioning, the captain did not have risk factors for a stroke. Other than his face, all other parts of him seemed to be working normally. The captain had good strength and sensation everywhere but his face.
One of the alternate possibilities was Bell’s palsy. It’s a condition that can happen unexpectedly and affects the facial nerve. There are two facial nerves, left and right that control all the muscles of the face, on each side. It is a relatively benign condition that resolves in several weeks. As the doctor and medic discussed the captain’s situation, the diagnosis of Bell’s palsy emerged as more likely. The doctor asked the medic to send a few pictures of the captain, expressionless and smiling.
The pictures above and a few other photos helped confirm the diagnosis of Bell’s palsy.
The doctor recommended the use of a common steroid medication that the crew had on board. As a result of this diagnosis, the medevac and the replacement captain, thousands of nautical miles away, were both cancelled.
The medic and captain were very pleased and assured by this service. Essentially, their minds were put at ease and the inconvenience and expense of having to delay the sea voyage and/or organize a medevac were avoided. The captain made a full recovery in two and a half weeks.
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