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August 23, 2016

Asthma

“DOCTOR AT SEA” a monthly Column in The Islander Magazine

Asthma

This is such a common condition that most of us will know someone who is affected. It can still be a killer but fortunately there are very effective forms of treatment these days.

The underlying problem is difficulty breathing caused by airways narrowing and airways congestion. The airways often narrow in response to an outside allergic stimulus such as pollen or the hairs of some animals such as cats. The congestion factor is caused by inflammation within the airways and produces sticky mucus material. This simply blocks the tubes but the combined effect of airways narrowing and airways congestion leads to increased difficulty with breathing.

The individual starts to wheeze (a high pitched noise on breathing out) and may have difficulty getting their words out. It is possible to grade the degree of breathless semi-quantitatively by observing a person’s speech ranging from the ability to speak in complete sentences through speaking in parts of sentences through to an inability to speak much at all. In the advance stage of severe asthma the person is desperately using their neck muscles to pull their rib cage open but the lungs will have gone critically silent and time may be short. In children this can be seen as the ribs sucking in rather than expanding as they attempt to breathe.

Fortunately most people do not reach these emergency conditions and their relatively mild condition is managed with an inhaler which allows delivery of medication to open up the narrowed airways – a reliever medication – usually a blue inhaler called Ventolin or, chemical name, salbutamol. The congestion is eased by inhalers usually containing anti-inflammatory steroids – a preventer medication – usually a brown inhaler called Becotide. The relievers work within minutes whereas the preventers take several hours and should be taken regularly to maintain control. The general rule is to use the relievers as often as is necessary each day to ensure that the preventer inhaler is not needed every single day. Some people who have only mild asthma will only need a reliever inhaler now and again and little else, perhaps before exercise or just when they have a cold.

Most people on medication know how to adjust their doses in case of, for instance, a common cold. Occasionally control is lost and stronger medication such as steroid tablets and maybe oxygen are required (anyone who becomes distressed due to asthma can benefit from oxygen treatment). These stronger emergency measures could be needed onboard when guests have left medication at home or become more cavalier about their care when on holiday.

Crew members ought not to be susceptible to this kind of emergency and its aggressive treatment because the MCA guidelines on asthma are careful and someone with unstable asthma cannot normally hold an unrestricted ENG1 certificate. The guidelines are relatively straightforward for individuals who have left their asthma behind in teenage but a number still cling to their inhalers long after maybe they do not need them and it is important to establish how necessary it is to have ongoing medication. The absence of any emergency crises involving oral steroids or hospital admission all help to make a favourable decision.

It is still surprising to me to come across ENG1 candidates with an asthma history and who have started to smoke – “fanning the flames” springs to mind – not only is it harmful in the short and long term but might impinge on fitness to go to sea. Fortunately the seafaring existence takes people away from pollen and small animals for much of the time and the low dust levels on luxury yachts is another advantage although dry air-conditioning can be unhelpful.

It is quite common to find asthma in children and young adults coexisting with hay fever and with a form of eczema affecting the creases on the limbs ie in front of the elbows and behind the knees. This condition is called atopy and atopic individuals generally have all three conditions to a greater or lesser extent. This predisposition is intrinsic and has a strong hereditary component but some people acquire extrinsic asthma in adult life as a result of exposure to certain materials such as glues and resins used in curing epoxy resins, or electronic soldering flux, or wood dusts in sawmilling or woodworking, or flour/grain/hay handling at docks/milling/malting/baking, isocyanates in vehicle spray painting or foam manufacturing – the list goes on and on. These occupational causes are well recognised and strenuous efforts need to be made to avoid exposure and possible sensitisation because, once sensitised, a person can be symptomatic with trace exposure.

Asthma is one of those common chronic diseases which can occasionally become acute and frightening. Management of both the chronic and acute phases is covered in MCA Approved Courses devoted to Medical Care Onboard Ship and some knowledge can clearly be crucial when that unexpected emergency arises.


Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca.

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  148. Una ingente cantidad de puntos de interés nacional e incluso mundial, una incontable cantidad de museos y centros culturales, redes de comunicaciones eficaces y rápidas la gran variedad de espacios de ocio y restauración son solo algunos de los aspectos que hacen de los vuelos baratos a Madrid una muy buena elección. Reconocida entidad Financiera requiere Asesores Comerciales para el área de Microfinanzas; con estudios Técnicos y/ tecnológicos y/ profesionales en carreras afines al sector administrativo financiero. Reconocida entidad financiera requiere para su equipo de trabajo hombre ó mujer, Tecnico Tecnologo en Gestion del Talento Humano titulado, experiencia en nomina, salud ocupacional y bienestar indispensable manejo de excel. Reconocido grupo empresarial del sector automotriz, requiere para su equipo de trabajo personal para desempeñar el cargo en mencion; debe cumplir con el siguiente perfil; Ingeniero Industrial, Administrador de Emperesas, telecomunicaciones Electronico, con experiencia en venta de servicios electronicos.

  149. Contacte para conocer todas las alternativas a su favor en cuanto a la intervención de todo tipo de aparatos electrodomésticos de la marca. En Córdoba puede encontrar el servicio técnico más indicado tanto para la reparación de electrodomésticos Bosch como para acciones en otras muchas marcas. Los operarios especializados del SAT que presentamos brindan reparación de secadoras de evacuación y de condensación.

  150. Asimismo, nuestro hotel alberga cafetería, restaurante, bar, aparcamiento, servicio de lavandería, servicio de habitaciones y 19 salas de conferencias y banquetes para diferentes eventos de hasta 00 participantes. Con esta exposición se consiguen reunir por primera vez en España los 14 lienzos que conforman las Visiones de España de Joaquín Sorolla, que pintó por encargo de la Hispanic Society de Nueva York.

  151. Según declaraciones de Carlos Román, director del Servicio BSH al Cliente Nuestra política de calidad estandarizada va acompañada de una serie de indicadores que nos permiten el seguimiento continuo y constante de nuestro servicio, a partir de los cuales establecemos nuestros planes de acción de mejora. Nuestros técnicos de frigoríficos son expertos en reparaciones de frigoríficos de todas las marcas.

  152. En el Servicio Técnico Siemens en Benicasim recomendamos que ante una vería de su aparato actúe con cautela, ya que puede empeorar el estado de este y encarecer la reparación. Lo primero es reconocer donde esta fallando nuestro electrodoméstico, después póngase en contacto con nosotros y solicite la asistencia a domicilio de un técnico para reparar su electrodoméstico.

  153. Según que prácticas, y este tipo de empresas captadoras”, han sido muy perjudiciales y han dañado a usuarios y a otras empresas, también a técnicos que hacen su trabajo honradamente y hacen su trabajo con profesionalidad sin ánimo de enriquecerse con trampas, simplemente con la satisfacción de realizar un trabajo bien hecho y que el cliente obtenga la reparación necesaria sin argucias ni trampas, haciendo de su trabajo un medio de vida , con el esfuerzo, formación y preparación.

  154. En todas las reparaciones que realizamos, dejamos la correspondiente factura, pues la factura es la mejor garantía que hay, no solo por si hay algún fallo en la reparación, que sera atendida con prioridad sobre los demás servicios, sino que también podrá usarla ante cualquier reclamación contra nuestra empresa en las Oficinas de defensa del consumidor.

  155. Al contactar con nuestros teléfonos de atención al cliente se le preguntará la marca de su frigorífico. Esto ayudará al técnico a proveer su unidad móvil con los recambios y herramientas necesarias en las averías más comunes según la marca y la descripción del desperfecto notado. Así el trabajo de reparación del frigorífico será mucho más eficiente con un tiempo de intervención mínimo. A continuación puede revisar las marcas principales de frigoríficos a reparar por nuestros técnicos.

  156. Yo he adquirido recientemente un frigorífico Fagor (normal, sin No Frost), en la tienda y en varios sitios en internet decía que era de 39 dbA, pero luego en la placa de características pone 42 dbA y la verdad es que el ruido de borboteo, el que hace el gas al circular, es bastante molesto. Yo no creo mucho en espiritus, pero el primer dia la verdad que hasta que descubrí que era la nevera pasó un rato… Es una mezcla como el aire que entra per una ventana medio abierta y alguien que te habla en voz baja…para flipar. Acabo de poner esto en la pagina de opiniones de bosch, lo pego aqui para asegurarme de que el comentario es visible.

  157. Vivecar es una empresa con experiencia en el mercado del alquiler de vehiculos sin conductor, aportamos todos y cada uno de los servicios que precisa a fin de que si estancia en las isla sea lo pero agradable posible. En el nordeste de la mi enlace isla se halla la provincia de Santa Cruz de Tenerife, donde podra gozar del aire maritimo del puerto ir de excursion a las montanas y admirar el esplendido panorama de la urbe. Arrendar un Turismo Deportivo te permite gozar de la velocidad y la libertad de conducir al aire libre.

  158. Si os interesa la belleza del paisaje, sus condicionantes y sus transformaciones humanas, si tienen interés por conocer la civilización humana y sus creaciones, si el amor por su entorno es su valor, si el respeto, la educación y el conocimiento os estimulan… BIENVENIDOS A TUS CIENCIAS SOCIALES. Hola, Matías, nuestros Servicios Técnicos Oficiales disponen de recambios para esos modelos se les suministra de inmediato desde nuestros servicios centrales. Hola, Pedro, aquí tienes el buscador para localizar el Servicio Técnico Oficial más próximo a tu domicilio. Me han confirmado en el servicio técnico que no hay problema por seguir utilizándolo, cosa que haré.

  159. Nota común al Grupo 45 .- Este grupo comprende la confección de prendas de vestir, sombreros, estolas y otros accesorios del vestido, alfombras, mantas y otros artículos a base de pieles finas corrientes y de sucedáneos imitación de piel (peletería ficticia), así como la transformación especializada de restos de pieles. Epígrafe 4 8.5.- Actividades anexas a la industria del mueble (acabado, barnizado, tapizado, dorado, etc.). Epígrafe 474.3.- Reproducción de textos imágenes por procedimientos tales como multicopistas, fotocopias por procedimientos fotográficos y electroestáticos, sistemas de reproducción de planos, etc.

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  162. Nuestros técnicos especialistas están en constante aprendizaje, por lo que están totalmente capacitados para llevar a cabo la reparación de cualquier nevera congelador Siemens. Después de explicarnos su problema, nuestro técnico más adecuado para su tipo de avería irá a su hogar el mismo día para solucionarselo. Una interminable lista de electrodomésticos para hacerles la vida mucho más snecilla y cómoda.

  163. En una Asamblea celebrada en la céntrica Puerta del Sol de Madrid, donde cumplen su quinta jornada los acampados han reclamado listas abiertas, circunscripción única y escaños proporcionales al número de votos. Vean ustedes a la señorita de la fotografía: se llama Maru Menéndez y actualmente es la portavoz del PSOE en la Asamblea de Madrid. Los manifestantes (pienso ir) seremos insultados en todos los medios frikis (los más vistos en tv) y no frikis. Tras una vida dedicada al servicio público, Manolo Chaves se retirará a vivir a una plaza de garaje.

  164. Realizamos reparación, instalación y mantenimiento de todos los equipos electrodomésticos de los que disponga su negocio. Si quiere una asistencia técnica experta y de garantías no lo dude, Servicio Técnico de Reparación Reparantia. Nuestro personal está altamente cualificado y preparado para proporcionarle un servicio satisfactorio y de alta calidad con asistencia a domicilio. Contamos con diferentes unidades móviles en todo Tenerife para una asistencia a domicilio rápida y eficaz. Marisa López: Llame por que se me averió la lavadora a las 5 de la tarde y ese mismo día el servicio técnico, me lo dejo reparado.

  165. Llamo al servicio de atención al cliente de Electrolux, que me dicen que se interesarán por esta situación. La lavadora que compre, porque he de comprar una lavadora nueva no será de ninguna marca que tenga este servicio técnico. Al lavavajillas también tuvo que sustituirle gran parte de la electrónica, conservo las facturas de su servicio técnico por la reparación.

  166. Importante entidad de salud de servicio pediátrico requiere Médico General con experiencia en paciente pediátrico para laborar turnos de 12 horas fines de semana cada 15 días. Reconocida entidad prestadora de servicios de salud solicita auxiliares de dieta con experiencia minimo de meses en alistar y distribuir dietas, excelente atencion al cliente y buenas relaciones interpersonales. Importante entidad de salud de servicio pediátrico requiere Médico General con experiencia en atención de paciente pediátrico para laborar turnos cada 4ta noche en servicio de urgencias.

  167. Robert Jennifer says:

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  169. Nuestra asistencia técnica es un servicio a domicilio, con lo que el cliente solo ha de preocuparse de recibir al técnicos el día programado. No lo olvide le ofrecemos una asistencia inmediata sin aumentos en la tarifa por ser urgente. Disponemos del servicio tecnico más eficaz y económico de reparacion de frigorificos y frigorificos industriales en la Comunidad de Madrid. Nuestros tecnicos ofrecen un servicio de repuestos, cambios de piezas y reparaciones de frigorificos de cualquier marca. Servicio tecnico a domicilio sin cobrar desplazamiento, ofreciendo un presupuesto totalmente ajustable y gratuito. Resolvemos cualquier tipo de avería y lo hacemos en menos de 24 horas con nuestro servicio tecnico.

  170. Somos el servicio técnico de reparación de electrodomésticos con profesionales que están preparados para aconsejarle la mejor opción en la reparación de todo tipo de electrodoméstico de gama blanca: lavadoras, secadoras, lavavajillas,cocinas eléctricas, hornos, campanas extractoras, termos. No compre electrodomésticos más potentes grandes de lo que realmente necesite, pues malgastará energía y pagará más. Si tu electrodoméstico no funciona bien, solicita la visita del técnico más cercano a tu domicilio.

  171. A través de nuestra Asistencia Online puedes tanto encontrar manuales de instrucciones, preguntas frecuentes consejos de limpieza y mantenimiento, como comprar online accesorios y repuestos originales para tu electrodoméstico. Introduce el modelo de producto (E-Nr) del electrodoméstico y el Servicio de Asistencia Técnica te mostrará toda la información disponible sobre el aparato. Reparación proporcionada por técnicos oficiales Bosch, especialmente formados para reparar tus electrodomésticos.

  172. Es un clásico de la literatura técnica sobre frío y aire acondicionado ya que se une la facilidad del texto a la amplitud del libro, ya que trata todos los aspectos de la refrigeración y el aire acondicionado, con muchos ejemplos y casos prácticos. Con la más moderna tecnología referente a la refrigeración, congelación, ultracongelación y envasado en atmósferas modificadas de los alimentos y bebidas. Esta tecnología es poco conocida en España, por lo que un libro como éste ayudará al conocimiento de sus posibilidades en la industria.

  173. Esta situación se hace evidente en foros de internet donde se pueden encontrar quejas de usuarios sobre el servicio técnico de Edesa que, en realidad, aluden a estas empresas pirata”. Las empresas pirata” etiquetan sus páginas web con los términos más utilizados por los usuarios de electrodomésticos Edesa cuando buscan su servicio técnico oficial. Empresas piratas están copando los primeros puestos en buscadores online haciéndose pasar por el servicio técnico oficial de Edesa.

  174. Moraleja de Enmedio, Alcalá de Henares, Daganzo de Arriba, Torrejón de Ardoz, San Fernando de Henares, Coslada, Mejorada del Campo, Velilla de San, Antonio, Rivas Vacia Madrid, Arganda del Rey. Antonio Muñoz – Servicio Técnico de Reparación de Electrodomésticos es una empresa situada en Rubi (Barcelona), especializada en la reparación de electrodomésticos y en la venta de recambios – originales y adaptables – para electrodomésticos de gama blanca. Nuestro servicio se complementa con la venta e instalación del sistema de osmosis, una solución muy interesante para garantizar la calidad del agua que consumimos en el hogar.

  175. Importante empresa del sector salud requiere Técnico y/ Tecnólogo en Archivística y/ estudiante de 7mo semestres de Archivística Bibliotecología con experiencia mínima de 2 años en elaboración y aplicación de tablas de retención documental y tablas de valoración documental, conocimientos en sistemas de información, manejo de personal y técnicas de calidad.

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  180. Prácticamente todo lo que utilizamos diariamente, coche, electrodoméstico, ordenadores, lámparas… está fabricados por piezas creadas unidas por otras piezas que se han realizado por decoletaje. La industria del Decoletaje permite la fabricación de numerosas piezas mecanizadas de medida pequeña, mediana y grande que se entregan en todo el mundo.

  181. Mettcom says:

    En Mecanizados Iterga estamos especializados en el Mecanizado de Precisión de piezas, fabricando piezas dentro de las tolerancias dimensionales y geométricas más exigentes. Una vez más, al igual que con la fabricación relacionada con la medicina, los seres humanos pueden depender de la precisión y fiabilidad de los componentes que entras en los productos y equipos. Esto dio lugar a una nueva clase de máquinas herramienta, máquinas multitarea (MTM), que están especialmente diseñadas para facilitar el fresado y el volteo dentro de la misma envolvente de trabajo.

  182. El corte separación de las piezas de la barra de metal plástico mediante un segador es la operación que define el decoletaje. Podemos realizar mecanizados de todo tipo de materiales. En Industrias Loher llevamos a cabo la producción de piezas necesarias en multitud de sectores tales como la aeronáutica, relojería, implantes dentales, valvulería, …etc.

  183. En el mecanizado por penetración la pieza es el cátodo y la herramienta (generalmente, de cobre grafito) tiene la geometría a mecanizar y es el ánodo. Nuestras tecnologias y medios de fabricación nos permiten garantizar acabados de calidad de acuerdo a las especificaciones de nuestros clientes.

  184. Información Empresas: Mecanizados De Precision Feyma Sl. Puede obtener más información en nuestra política de cookies. Podemos partir de un bloque de 400kg, desbastarlo entero, acabar la pieza y haber entrado en los nervios de un molde con una herramienta de 0,5mm, eso hay pocas máquinas en el mundo que lo puedan hacer.

  185. Generalmente los examinan muy a fondo para descubrir el grado de competencia del proveedor, dado que cualquiera que decide subcontratar una pieza, busca sobre todo una garantía de calidad a precios competitivos y una estricta puntualidad en las entregas de las piezas a ser subcontratadas.

  186. ELURSA es una empresa en continuo crecimiento, enfocada y preparada para abarcar nuevos mercados y clientes, donde el desarrollo de las habilidades y capacidades humanas junto con la infraestructura adecuada a la necesidad del mercado hace que ELURSA sea una de las empresas con mayor proyección de futuro del sector.

  187. Una vez que los materiales han sido mecanizados, se les somete a un proceso de lavado y filtrado, que elimina rebabas e impurezas antes de pasar a la fase de inspección final del proceso de fabricación. Si continúa navegando está dando su consentimiento para la aceptación de las mencionadas cookies y la aceptación de nuestra política de cookies , pinche el enlace para mayor información.

  188. Esto nos permite ofrecer a nuestros clientes grandes series de piezas de revolución con alta calidad y precisión y bajo coste. Si necesitas una empresa que fabrique piezas de calidad, seriedad en los plazos de entrega, fiabilidad. El contenido de la información de Talleres Decoletaje La Precision Sl, empresa ubicada en Tarazona De La Mancha, proceden de la base de datos de INFORMA D&B.

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