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46 Cards in this Set
- Front
- Back
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Diving Supervisor’s Responsibilities
(20-1.3) |
Ensures Diving Team:
- Is familiar with all recompression procedures. - Knows the location of the nearest, certified chamber. - Knows how to contact a DMO if one not on site. - All are BLS qualified. |
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Defibrillator use
(20‑2.1.1) |
- If within 10 minutes the diver is kept at surface until pulse is obtained.
- If within 20 minutes, the pulseless diver is brought to the surface at 30 fpm and defibrillated. |
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The most common symptom of DCS
(20‑3.2.1) |
Joint pain!
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Treatment of AGE or Serious DCS
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Compress to 60 if improvement in Sx's TT6, if no change or worsening Sx's compress on air to DOR or significant improvement not to exceed 165 fsw, complete 30 min period breathing air or treatment gas TT6A
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Hallmark of Type I pain
(20‑3.2.1) |
-Dull, aching and localized.
-Always present at rest. -Usually unaffected by movement. |
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Prescribing and Modifying Treatments
(20-1.4) |
Only by recommendation of a DMO, and with concurrence of CO or OIC.
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Symptomatic Omitted Decompression Treatment
(20-3.7) |
-If diver surfaced from 50 fsw or shallower, compress to 60, begin Treatment Table 6.
-If the diver surfaced from greater than 50 fsw, compress to 60 or DOR, not to exceed 165 fsw, begin Treatment Table 6A. |
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Altitude Decompression Sickness (joint pain was present but resolved before reaching one ata from altitude)
(20-3.8.1) |
May be treated with 2 hours of 100% O2 on surface followed by 24 hours observation.
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The primary objectives of recompression treatment
(20-4.1) |
-Compress gas bubbles, relieving local pressure and restarting blood flow,
-Allow time for bubble resorption -Increase blood O2 content and O2 delivery to injured tissues |
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Guidance on Recompression Treatment
(20-4.2) |
-Treat promptly and adequately.
-Don't ignore minor symptoms. -Follow TT unless changes are recommended by DMO. -If multiple symptoms occur, treat the most serious. |
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Treatment Table 5 is used for
(20-5.2) |
-Type I DCS with complete relief in 10 min's (except cutis marmorata)
-Asymptomatic omitted D -Treatment of resolved Sx's following in-water D -Follow-up treatments of residual Sx's -Carbon monoxide poisoning -Gas gangrene |
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Treatment Table 6 is used for
(20-5.3) |
-AGE
-Type II DCS -Type I DCS where relief is not complete within 10 minutes at 60 or where pain is severe neuro can not be performed before recompression -Cutis marmorata -Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation -Asymptomatic omitted D -Symptomatic uncontrolled ascent -Recurrence of Sx's shallower than 60 fsw |
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Treatment Table 6A is used for
(20-5.4) |
Treatment of AGE or DCS when Sx's remain unchanged or worsen within the first 20 min's at 60.
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Treatment Table 4 is used
(20-5.5) |
When determined that the patient would receive additional benefit at DOR.
Time at depth shall be between 30 to 120 min's |
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Sleeping in chamber
(20‑5.6.5) |
Patient may sleep anytime except when breathing O2 deeper than 30 feet.
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Minimum manning requirements for chamber
(20-7.1) |
Minimum 3 (SUP/IT/DRIVER)
In emergency 2 (SUP/IT) |
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Maximum Permissible Chamber Exposure Times at Various Temperatures
(Table 20‑4) |
Over 104°F - No treatments
95–104°F - Table 5, 9 (2 hours) 85–94°F - Tables 5, 6, 6A, 1A, 9 (6 hours) Under 85°F - All treatments |
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Patient Hydration
(20‑7.5.1) |
1-2 liters of water, juice, or non-carbonated drink, over course of a TT 5 or 6, is usually sufficient. Patients with Type II Sx's, or Sx's of AGE, should have IV fluids, drip rate of 75-100 cc/hour. Urine output should be 0.5cc/kg/hr, or clear colorless urine.
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Chamber Ventilation
(20-7.6) |
Ventilation rate of 2 acfm for each resting person, 4 acfm for each active person.
If ventilation must be interrupted for any reason, time should not exceed 5 min's in any 30 min period. When ventilation resumed, twice the vol. of ventilation should be used for the time of interruption and then the basic ventilation rate should be used again. |
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Use of DMO as Inside Tender
(20‑7.8.3) |
DMO should lock in and out as patient’s condition dictates, should not commit to the entire treatment unless absolutely necessary.
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Non-Diver Inside Tender
(20‑7.8.4) |
-Current diving physical
-Navy physical standards (PRT) -Pressure test -Inside Tender Qual. |
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All chamber occupants may breathe 100 percent oxygen at what depth?
(20‑7.8.6) |
45 feet or shallower without locking in additional personnel
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Inside tender surface interval between treatments
(20‑7.8.7) |
Tenders should allow a SI of at least 18 hours between consecutive treatments on TT 1A, 2A, 3, 5, 6, and 6A, and at least 48 hours between consecutive treatments on TT 4, 7, and 8.
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Pulmonary oxygen toxicity is likely to develop on
(20‑7.11.2) |
On TT 4, 7, or 8 or with repeated TT 5, 6, or 6A (especially with extensions)
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Procedures in the Event of CNS Oxygen Toxicity (20‑7.11.1.1)
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-1st sign of CNS O2 tox:
Off O2, breathe chamber air, 15 min's after all Sx's subsided, resume O2 at point of interruption -2nd CNS O2 hit or if 1st is convulsion: Off O2, after all symptoms completely subside, come up 10 feet at 1 fsw/min. (For convulsion, begin travel when Pt fully relaxed and breathing normally) Resume O2 at the at the point of interruption. |
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Post-Treatment Observation Period patient
(20-8.1) |
-Pt's treated on a TT 5 should remain at chamber facility for 2 hours.
-Pt's treated for Type II DCS or required TT 6 for Type I and had complete relief remain at chamber facility for 6 hours -Pt treated on TT 6, 6A, 4, 7, 8 or 9 are likely to require hospitalization |
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Flying After Treatments - Patient
(20-8.3) |
Pt's with residual symptoms should fly only with concurrence of a DMO.
Pt's treated for DCS or AGE and have complete relief should not fly for 72 hours after treatment, at minimum. |
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Flying After Treatments - Tenders
(20-8.3) |
Tenders on TT 5, 6, 6A, 1A, 2A, or 3 should have a 24-hour SI before flying.
Tenders on TT 4, 7, and 8 should not fly for 72 hours. |
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Treatment of Residual Symptoms
(20-8.4) |
For persistent Type II symptoms, daily treatment on TT 6 may be used, but/or twice-daily treatments on TT 5 or 9 may also be used.
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Returning to Diving after Re-compression Treatment
(20-8.5) |
Divers diagnosed with AGE or Type II DCS may be medically cleared to return to diving 30 days after initial diagnosis and treatment by DMO
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Once recompression therapy is started, it should be completed unless
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-Death
-Continuing treatment would place the chamber occupants in mortal danger -In order to treat another more serious medical condition |
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Fluids intake for pulmonary DCS
(20‑11.1.2) |
No fluids administered Pt's suffering from the chokes (pulmonary DCS).
Oral fluids (half-strength glucose and electrolyte solutions) are acceptable if the diver is able to tolerate. |
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Primary and Secondary Emergency Kits
(20-12.1) |
-Primary kit contains diagnostic and therapeutic equipment, available immediately, located inside the chamber during all treatments.
-Secondary kit contains equipment and medicine that doesn't need to be available immediately, |
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AED and ACLS requirements
(20-12.2) |
-All diving commands shall maintain an automated external defibrillator
-All command chambers that participate in area bends watch shall maintain drugs recommended by the American Heart Association for ACLS. |
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Tender O2 TT5 requirements
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Tender breathes 100% O2 during ascent from 30 to surface. If the tender had previous hyperbaric exposure in the previous 18 hours, an additional 20 min's of O2 breathing is required.
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Tender O2 TT6 requirements
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Tender breathes 100% O2 during last 30 min. at 30 and during ascent to surface for unmodified table or where only 1 extension at 30 or 60. If there has been more than 1 extension, the O2 breathing at 30 is increased to 60 min's. If tender had hyperbaric exposure within past 18 hours additional 60-min's of O2 period is taken at 30.
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Tender O2 TT6A requirements
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Tender breathes 100% O2 during the last 60 min's at 30 and during ascent to surface for unmodified table or where only 1 extension at 30 or 60. If there has been more than 1 extension, the O2 breathing at 30 is increased to 90 min's. If tender had hyperbaric exposure within past 18 hours, an additional 60 min's of O2 breathing is taken at 30.
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Tender O2 TT9 requirements
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Tender breathes 100% O2 during last 15 min's at 45 and during ascent to surface regardless of ascent rate used.
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Pressure test required on chamber when?
(21-6.2) |
-Initially installed
-After major overhaul or repair -At 2-year intervals thereafter |
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Signs and Symptoms of Shock
(5B-4.1) |
-Respiration shallow, irregular, labored
-Pupils dilated -Cyanosis (blue lips/fingernails) -Skin pale or ashen gray; wet, clammy, cold -Pulse weak and rapid, or may be normal -Blood pressure drop -Possible retching, vomiting, nausea, hiccups -Thirst |
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Symptoms of Hypoxia
(3‑5.1.2) |
-Increased breathing
-SOB, (dyspnea) -Confusion or euphoria -Inability to concentrate -Increased sweating -Drowsiness -Headache -Loss of consciousness -Convulsions |
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Symptoms of Carbon Monoxide Poisoning
(3‑5.8.2) |
-Headache
-Dizziness -Confusion -Nausea -Vomiting -Tightness across the forehead |
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Management of Asymptomatic Omitted D
(No decompression stops) |
Observe on surface for 1 hour
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Management of Asymptomatic Omitted D
(Deeper than 30 fsw) |
- TT 6
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Management of Asymptomatic Omitted D
(Missed a stop deeper than 50 fsw) |
Compress to 165 fsw and start Treatment Table 6A
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Internal chamber temperature can be measured using what types of thermometers (Table 20-4)
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Thermometers:
-Electronic -Bimetallic -Alcohol -Liquid crystal |
