Cerebrovascular Accident

An elderly male passenger presented with confusion and L sided hemiplegia and was admitted for investigation and treatment of acute stroke. The patient had vomited and was thought to have aspirated. The ship was two days sailing to the next port and so medical evacuation was not possible due to the ship's isolated position. We were faced with the need to provide medical and nursing care for two days at sea. As the patient had a poor gag reflex and copious oral secretions, we felt we had no option but to intubate and ventilate to protect his airway. He already had x-ray signs of aspiration pneumonia. He was intubated using fentanyl, propofol and suxamethonium and ventillated on our UniVent. He was subsequently allowed to breathe for himself in an assisted ventilation mode with lightened sedation. The efficacy of the ventilation was monitored using pulse oximetry and capnography. We phoned the hospital ahead of arrival to our next port and arranged for an ambulance staffed with a doctor and paramedics to meet the ship on docking and transfer our patient on a portable ventilator to an onshore intensive care unit.