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90 Cards in this Set
- Front
- Back
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Responsibilities of inside tender?
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1. Monitor for signs of relief
2. Communication with Chamber Sup 3. First aid, Neuro, Vitals 4. Administer Tx gas 5. Assist pt as necessary, ensure good blood circulation 6. Ensure hearing protection worn 7. Ensure door seal |
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How long is Chamber CO2 absorbent good for? |
Until expiration on bucket. |
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Access requirements for chamber occupants?
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Never attempt Tx longer than TT6 unless access to inside tender, Double-Lock req’d for TT 4,7,8
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Chamber manning?
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4+ Optimum
3 Minimum 2 Emergency |
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Optimum manning for chamber?
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Dive Sup
Outside Tender (driver) Outside Tender (comms/logs) Inside Tender |
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DMO consultation requirements?
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1.Shall be contacted ASAP when possible Tx
2.If at all possible prior to TT 4,7,8 3.Prior to PT release |
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Chamber Sup responsibilities?
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1.Is thoroughly familiar with all recompression procedures
2.Knows location of nearest, certified chamber 3.How to contact DMO 4.Knows basic CPR |
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What is shock?
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Loss of blood flow, resulting in a drop of blood pressure and decreased circulation
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Sx of shock?
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TV SPARC CUBE:
Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank |
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Tx for shock?
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ABC’s
first-aid lay down on O2 elevate legs keep warm give nothing by mouth |
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12 Cranial nerves?
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olfactory,optic,oculomotor,
trochlear,trigeminal,abducens, facial,acoustic,glossopharyngeal, vagus,spinal accessory, hypoglossal. |
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Sx recurrence?
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If less than 60 fsw, go back to 60 fsw and restart TT6
if deeper than 60 fsw, go to depth of relief, not to exceed 165 fsw and restart TT6A |
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Tx options for residual Sx?
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1.DMO consult
2.Daily TT6 3.2x daily TT5 or TT9 |
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Death during Tx?
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Consult DMO
If during initial compression to 60 fsw, convert to AIR/O2 table and “dive” accordingly If during ascent to 30 fsw, ascend @ 30 fpm to 30 fsw, Tender breaths O2 for req’d time according to table notes If when leaving depth for TT 4,7,8, treat per table & contact NEDU |
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Pulseless Diver?
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ACLS w/in 10 min, keep at surface (CPR)
ACLS NOT w/in 10 min, press to 60 fsw If in chamber & ACLS arrives w/in 20 min, surface Avoid taking pulseless diver to depth If tender owes, ensure all “D” stops are met on way to surface |
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What type of IV fluid is allowed?
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Normal Saline
Lactated Ringers Solution |
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IV rate?
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75-100 cc / hour
**Same as O2 regulator setting |
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Urinary Output?
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0.5cc/kg/hr
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Adequate hydration?
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1-2 liters w/ TT5 or TT6
Water or non-carbonated |
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What is immersion pulmonary edema?
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Fluid in the lungs
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What are the Sx/Tx of immersion pulmonary edema?
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Sx = Cough, shortness of breath, bloody mucous, no chest pain
Tx = ON O2 |
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What is facial baroparesis?
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Facial paralysis/numbness
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CNS stands for?
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Central Nervous System:
Brain Spinal Cord |
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PNS stands for?
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Peripheral Nervous System:
Cranial nerves Spinal nerves Sympathetic nervous system |
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DCS Type I Sx?
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Pain in joints
Marbling skin Swelling/pain in lymph nodes |
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What are lymphatic Sx?
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Localized pain and swelling at lymph nodes
**Recompression may treat pain promptly but swelling may persist |
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Marbeling (cutis marmorata)?
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Type I Sx, Tx as Type II
Intense itch increases to bruising/swelling |
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DCS Type I Tx?
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Press to 60 fsw, if complete relief in 10 min, TT5, if not, TT6
**Musculo-skeletal pain w/o change after 2nd O2 period may be orthopedic injury, need DMO approval for TT5 |
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DCS Type I pain?
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deep dull ache
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DCS Type II Sx?
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Neurological
Staggers (inner ear) Chokes (cardio pulmonary) |
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DCS Type II pain?
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Viceral: Vague in chest/abdomen
Girdle: radiates from spine around body |
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DCS Type II Tx?
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Press to 60 fsw, during 1st 20 min on O2
If Sx improve, TT6 If Sx unchanged or worsening, press to D.O.R., N.T.E. 165 fsw, TT6A |
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Arterial Gas Embolism Sx
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near immediate onset of:
dizziness, paralysis/weakness large areas of abnormal sensation vision convulsions personality changes **Pain only not AGE |
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Arterial Gas Embolism Tx?
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Treat as Type II DCS
Press to 60 fsw, during 1st 20 min on O2 If Sx improve, TT6 If Sx unchanged or worsening, press to D.O.R., N.T.E. 165 fsw, TT6A |
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Altitude DCS?
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If ONLY joint pain resolved by 1 ATA, 24 hrs observation
If other Sx or Pain by 1 ATA, On O2, to chamber, treat accordingly even if Sx resolve |
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Tx for Non-Diving Patients?
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Smoke inhalation
CO poison Gas gangrene Crush injuries Necrotizing soft tissue Burns Selected wounds |
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WHEN CAN SYMPTOMS OF CNS O2 TOXICITY OCCUR?
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O2 PP GREATER THAN:
1.3 ATA wet or 2.4 ATA dry w/ Sx usually at 1.6 ATA |
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CNS O2 TOX Sx?
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Visual: blurry, tunnel
Ear: tinnitus, bells, machinery Nausea: feeling sick Twitching/Tingling (facial or extremities) Irritability: confusion, aggitation, anxiety, change in mental status Dizziness: clumsyness, unusual fatigue, coordination Convulsions. Little or no warning, can occur first VENTID-C |
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CNS O2 hit (1st Hit, non-convulsive)?
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Off O2
Wait 15 min after Sx passed On O2 at P.O.I. |
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CNS O2 hit (2nd hit or 1st convulsion)?
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Off O2
wait for Sx to subside ascend 10 fsw @ 1 fpm On O2 at P.O.I. |
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CNS O2 hit (3rd hit or 2nd convulsion)?
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Off O2
Contact DMO for Tx modification |
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Impending natural disaster/mechanical failure?
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If deeper 60 fsw, ascend to 60 fsw
All on O2, continue/convert to AIR/O2 table O2 time = sum of all “D” stops deeper than current depth Continue schedule breathing O2 continuously If NO MORE TIME, ascend @ 10 fpm max Transport to nearest chamber ON O2 |
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Strength scale?
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0=Paralized
1=Flicker of movement 2=Cannot move against gravity 3=Cannot resist examiner 4=Slight resistance 5=NORMAL |
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In-water recompression on AIR?
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Follow TT 1A as close as possible
Stay at max depth for 30 minutes Do not use stops shorter than 1A |
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In-water recompression on O2?
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Purge UBA 3x with O2
Descend to 30 fsw with standby 60/90 min @ 30 fsw for DCS TYPE I/II 20 fsw for 60 min. 10 fsw for 60 min. Surface O2 for 3 hours If Sx persist or recur, transport to recompression facility |
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Type II Sx after in-water decompression?
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Ominous sign, should be considered life threatening
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Symptomatic Omitted Decompression?
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TT6, 50 fsw to surface
TT6A, 50-165 fsw TT8, 165 fsw or deeper |
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Max time on O2 on surface?
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12 Hours
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When can everyone in chamber be on O2?
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45 fsw
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Chamber vent rates?
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AIR: PT 2 ACFM, IT 4 ACFM (w/ overboard dump)
O2: PT 12.5 ACFM, IT 25 ACFM (no bibs dump) |
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Chamber Secondary Air?
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Must press IL and OL 1X to 165 fsw
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Chamber Primary Air?
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Must press IL 1X and OL 2X to 165 fsw
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Fire in chamber?
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Greatest risk in chamber
Burns 2-6x faster Limit O2 to 25% Max Approved electrical equipment Approved clothing NO OILS |
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Chamber O2 %%?
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19-25%
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Chamber CO2 %%?
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1.5% (1.5/ATA)
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Chamber temperature limits?
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Up to 84*F Unlimited
85-94*F 6 hrs 95-104*F 2 hrs +104*F NO TREATMENTS |
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When to eat in the chamber?
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When O2 mask is off
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When to sleep in the chamber?
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Cannot sleep deeper than 30 fsw while on O2
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Minimum TT a chamber must be able to do?
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TT6A
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When are chambers pressure tested?
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1.Initially
2.Major overhauls 3.Every 2 years |
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STATS: TT9
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Ascent: 20 fpm
IT O2: O2 last 15 min @ 45 fsw AND ascent to surface |
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STATS: TT5
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Ascent: 1 fpm
Extensions: 2 @ 30 fsw IT O2: O2 30 fsw to surface. If prev. hyper. exp. last 18 hrs: O2 last 20 min @ 30 fsw and 30 fsw to surface. |
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STATS: TT6
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Ascent: 1 fpm
Extensions: 2 @ 60 fsw, 2 @ 30 fsw IT O2: O2 last 30 min @ 30 fsw and to surface Up to 1 extension: last 30 min @ 30 fsw and to surface More than 1 extension: last 60 min @ 30 fsw and to surface If prev. hyper. exp. last 18 hrs: Additional 60 min O2 @ 30 fsw |
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STATS: TT6A
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Ascent: 3 fpm 165 to 60 fsw, 1 fpm 60 fsw to surface
Extensions: 2 @ 60 fsw, 2 @ 30 fsw IT O2: O2 last 60 min @ 30 fsw and to surface Up to 1 extension: last 90 min @ 30 fsw and to surface If pref. hyper. exp. last 18 hrs: Additional 60 min @ 30 fsw |
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AIR TT
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MAX 100 fsw
TT 1A = “Complete relief” by 66 fsw TT 2A = “Complete relief” deeper than 66 fsw MAX 165 fsw TT 3 = “Type II” Sx relieved w/in 30 min @ 165 fsw TT 4 = “Type II” Sx NOT relieved w/in 30 min @ 165 fsw |
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USES for TT4
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Extended time at 165 fsw (up to 2 hours)
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USES for TT7
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Extension at 60 fsw (min 12 hours)
Heroic measure for non-responding patient |
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Descent Rate for a TT?
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20 fpm (15 seconds / 5 fsw)
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STATS: Diver candidate pressure test?
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1. Must have physical
2. Press to 60 fsw @ 75 fpm (as tolerated) 3. 10 minutes @ 60 fsw, ascend to surface @ 30 fpm 4. Remain 15 min @ immediate chamber site and 1 HR at test facility |
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After TT, how long does Tender have to wait before diving?
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After TT 1A,2A,3,5,6,6A:
18 hours before "No D" dive 24 hours before "D" dive After 4,7,8 : 48 hours |
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How long must inside tender remain in immediate vicinity of the chamber? w/in 60 min recall of chamber?
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one hour, 24 hours
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What kind of equipment is contained in the primary med kit?
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diagnostic and therapeutic
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"Normal" ranges for vitals?
PT is WNL: Within normal limits |
BP: 120/80
Pulse: 60-100 BPM Temp: 98.6*F Rpm: 14-18 |
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What is required for barotrauma (a squeeze)?
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Gas filled space
Rigid walls Ambient Pressure Change Venous/Arterial Blood Drainage/Supply Enclosed Space |
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Name the 5 POIS'
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Mediastinal Emphysema
Subcutaneous Emphysema Tension Pneumothorax Simple Pneumothorax Arterial Gas Embolism |
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What is a Tension Pneumothorax? Sx?
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air leakage from lung to plural space cannot exit, builds up pressure
Sx: Similar to simple but become progressively worse |
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What is a Simple Pneumothorax? Sx?
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a one-time leakage from lung to plural space
Sx: Sudden, sharp chest pain, shortness of breath, labored breathing, rapid heart rate, a weak pulse, and anxiety |
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What are the three stages of a convulsion?
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Tonic: locked up
Clonic: thrashing Postdictal: depressed |
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Treatment gasses?
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0-60 fsw 100% O2
61-165 fsw 50/50 N2O2 166-225 fsw HeO2 |
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Pulmonary O2 toxicity? Sx?
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Burning sensation in chest that can increase to pain on inspiration
Cause: long exposure to PP O2 levels above 0.5 ATA |
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WHAT IS THE DIRECT BUBBLE EFFECT?
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BUBBLES FORM IN TISSUES AND BLOODSTREAM AND OBSTRUCT FLOW OR CAUSE PRESSURE LEADING TO HEMORRHAGE.
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DCS - WHAT IS THE PRIMARY CAUSE FOR INJURY TO SPINAL CORD, MUSCULOSKELETAL AND INNER EAR DCS?
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AUTOCHTHONOUS BUBBLES: PUT PRESSURE ON NERVE ENDINGS, STRETCH AND TEAR TISSUE LEADING TO HEMORRHAGE AND INCREASE PRESSURE IN TISSUE REDUCING BLOOD FLOW
(DIRECT BUBBLE EFFECT OF DCS) |
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DCS - WHAT IS SECONDARY CAUSE FOR INJURY TO THE SPINAL CORD?
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VENOUS BUBBLES: CAN PARTIALLY OR COMPLETELY BLOCK VEINS (VENOUS OBSTRUCTION) RESULTING IN HYPOXIA, CELL INJURY AND DEATH.
(DIRECT BUBBLE EFFECT OF DCS) |
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DCS - WHAT IS THE PRIMARY CAUSE FOR INJURY TO THE PULMONARY SYSTEM?
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VENOUS GAS EMBOLISM (VGE): BUBBLES TRAVEL AS EMBOLI AND BLOCK FLOW OF BLOOD THROUGH LUNG LEADING TO PULMONARY EDEMA, HYPOXIA AND HYPERCAPNIA.
(DIRECT BUBBLE EFFECT OF DCS) |
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DCS - WHAT IS THE PRIMARY CAUSE FOR INJURY TO THE CEREBRAL SYSTEM?
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ARTERIAL GAS EMBOLISM (AGE): BUBBLES TRAVEL AS EMBOLI AND BLOCK THE SUPPLY OF BLOOD CAUSING HYPOXIA, CELL INJURY AND DEATH. AGE AND AUTOCHOTONOUS BUBBLE FORMATION ARE THE PRIMARY MECHANISM FOR INJURY IN CEREBRAL DCS.
(DIRECT BUBBLE EFFECT OF DCS) |
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WHAT IS THE INDIRECT BUBBLE EFFECT?
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OFF-GASSING CAUSES LEAKY BLOOD VESSELS WHICH FILL VOIDS CAUSE BY BUBBLE FORMATION FORMING A CLOT WHICH THE BODY TREATS AS A FOREIGN BODY. EXTREME CASES WILL SEND PATIENT INTO SHOCK.
THIS USUALLY HAPPENS OVER A LONGER PERIOD OF TIME THAN DIRECT BUBBLE EFFECT. CLOTS WILL NOT RECOMPRESS AND TX WILL INVOLVE OTHER THERAPIES. |
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WHAT DEPTHS FOR SHALLOW WATER DECOMPRESSION TABLE?
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30-50 FSW, ONE FOOT INCREMENTS
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WHAT IS THE RNT EXCEPTION RULE
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WHEN REPETITIVE DIVING, THE BOTTOM TIMES OF THE DIVES PERFORMED IN SERIES CAN BE ADDED TOGETHER, THE DEEPEST DEPTH OF THE SERIES IS USED AND THE TABLE/SCHEDULE WHICH PRODUCES THE SHORTEST DECOMPRESSION TIME OR NO-D TIME CAN BE USED.
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WHAT IS S.L.E.D.?
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SEA LEVEL EQUIVALENT DEPTH
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WHAT DIVES ARE CONSIDERED EXCEPTIONAL EXPOSURE?
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1. DEEPER THAN 190 FSW
2. IN-WATER DECO GREATER THAN 90 MIN. 3. SURD02 WITH MORE THAN 4 O2 PERIODS |
