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53 Cards in this Set
- Front
- Back
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Diving Supervisor’s Responsibilities |
To ensure that every member of the diving team:
- Is thoroughly familiar with all recompression procedures. - Knows the location of the nearest, certified recompression facility. - Knows how to contact a qualified Diving Medical Officer if one is not at the site. - Has successfully completed Basic Life Support training. |
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Defibrillator use
(20‑2.1.1) |
within 10 minutes, the stricken diver should be kept at the surface until a pulse is obtained, within 20 minutes, the pulseless diver shall be brought to the surface at 30 fpm and defibrillated
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The most common symptom of decompression sickness is
(20‑3.2.1) |
joint pain
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Treatment of Arterial Gas Embolism or Serious Decompression Sickness
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Compress to 60 feet if improvement in symptoms TT6, if unchanged or worsening severe symptoms compress on air to depth of relief or significant improvement not to exceed 165 fsw, complete 30 min period breathing air or treatment gas TT6A
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The hallmark of Type I pain
(20‑3.2.1) |
dull, aching quality and confinement to particular areas. It is always present at rest and is usually unaffected by movement.
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Prescribing and Modifying Treatments
(20-1.4) |
Only with the recommendation of a Diving Medical Officer, with the concurrence of the Commanding Officer or Officer in Charge.
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Symptomatic Omitted Decompression Treatment
(20-3.7) |
If the diver surfaced from 50 fsw or shallower, compress to 60 fsw and begin Treatment Table 6. If the diver surfaced from a greater depth, compress to 60 fsw or the depth where the symptoms are significantly improved, not to exceed 165 fsw, and 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) |
the individual may be treated with two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation.
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The primary objectives of recompression treatment
(20-4.1) |
-Compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow,
-Allow sufficient time for bubble resorption -Increase blood oxygen content and thus oxygen delivery to injured tissues |
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Guidance on Recompression Treatment
(20-4.2) |
-Treat promptly and adequately. The effectiveness of treatment decreases as the length of time between the onset of symptoms and the treatment increases.
-Do not ignore seemingly minor symptoms. They can quickly become major symptoms. -Follow the selected treatment table unless changes are recommended by a Diving Medical Officer. -If multiple symptoms occur, treat for the most serious condition. |
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Treatment Table 5 is used for
(20-5.2) |
-Type I DCS with complete relief in 10 minutes (except cutis marmorata)
-Asymptomatic omitted decompression -Treatment of resolved symptoms following in-water recompression -Follow-up treatments for residual symptoms -Carbon monoxide poisoning -Gas gangrene |
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Treatment Table 6 is used for
(20-5.3) |
-Arterial gas embolism
-Type II DCS -Type I DCS symptoms where relief is not complete within 10 minutes at 60 feet or where pain is severe and immediate recompression must be instituted before a neurological examination can be performed -Cutis marmorata -Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation -Asymptomatic omitted decompression -Symptomatic uncontrolled ascent -Recurrence of symptoms shallower than 60 fsw |
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Treatment Table 6A is used for
(20-5.4) |
treatment of arterial gas embolism or decompression symptoms when severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw.
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Treatment Table 4 is used
(20-5.5) |
when it is determined that the patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw. The time at depth shall be between 30 to 120 minutes
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Sleeping in chamber
(20‑5.6.5) |
The patient may sleep anytime except when breathing oxygen deeper than 30 feet.
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Minimum manning requirements for chamber
(20-7.1) |
The minimum team for conducting any recompression operation shall consist of three individuals. In case of emergency, the recompression chamber can be manned with two individuals
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Maximum Permissible Recompression 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) |
One to two liters of water, juice, or non-carbonated drink, over the course of a Treatment Table 5 or 6, is usually sufficient. Patients with Type II symptoms, or symptoms of arterial gas embolism, should be considered for IV fluids, dripping at a rate of 75 to 100 cc/hour. Urine output should least 0.5cc/kg/hr, or clear colorless urine.
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Chamber Ventilation
(20-7.6) |
A ventilation rate of two acfm for each resting occupant, and four acfm for each active occupant.
If ventilation must be interrupted for any reason, the time should not exceed 5 minutes in any 30-minute period. When ventilation is resumed, twice the volume 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 Diving Medical Officer as Inside Tender
(20‑7.8.3) |
the Medical Officer should lock in and out as the patient’s condition dictates, but should not commit to the entire treatment unless absolutely necessary.
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Non-Diver Inside Tender
(20‑7.8.4) |
Qualifications may be achieved through Navy Diver Inside Tender PQS. Prerequisites: Current diving physical exam, conformance to Navy physical standards, and diver candidate pressure test.
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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 surface interval of at least 18 hours between consecutive treatments on Treatment Tables 1A, 2A, 3, 5, 6, and 6A, and at least 48 hours between consecutive treatments on Tables 4, 7, and 8.
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Pulmonary oxygen toxicity is likely to develop on
(20‑7.11.2) |
On Treatment Tables 4, 7, or 8 or with repeated Treatment Tables 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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At the first sign of CNS oxygen toxicity, the patient should be removed from oxygen and allowed to breathe chamber air. Fifteen minutes after all symptoms have subsided, resume oxygen breathing. If symptoms of CNS oxygen toxicity develop again or if the first symptom is a convulsion, remove the mask, after all symptoms have completely subsided, decompress 10 feet at a rate of 1 fsw/min. For a convulsion, begin travel when the patient is fully relaxed and breathing normally. Resume oxygen breathing at the shallower depth at the point of interruption.
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Post-Treatment Observation Period patient
(20-8.1) |
Patients treated on a Treatment Table 5 should remain at the recompression chamber facility for 2 hours. Patients who have been treated for Type II decompression sickness or who required a Treatment Table 6 for Type I symptoms and have had complete relief should remain at the recompression chamber facility for 6 hours
Patients treated on Treatment Tables 6, 6A, 4, 7, 8 or 9 are likely to require a period of hospitalization |
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Flying After Treatments - Patient
(20-8.3) |
Patients with residual symptoms should fly only with the concurrence of a Diving Medical Officer. Patients who have been treated for decompression sickness or arterial gas embolism and have complete relief should not fly for 72 hours after treatment, at a minimum.
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Flying After Treatments - Tenders
(20-8.3) |
Tenders on Treatment Tables 5, 6, 6A, 1A, 2A, or 3 should have a 24-hour surface interval before flying. Tenders on Treatment Tables 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 Table 6 may be used, but twice-daily treatments on Treatment Tables 5 or 9 may also be used
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Returning to Diving after Recompression Treatment
(20-8.5) |
Divers diagnosed with AGE or Type II DCS may be medically cleared to return to diving duty 30 days after initial diagnosis and treatment by a DMO
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Once recompression therapy is started, it should be completed unless
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death, continuing the treatment would place the chamber occupants in mortal danger or in order to treat another more serious medical condition
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Death During Treatment
(20-10.1) |
If death occurs following initial recompression to 60, 165, or 225 on Treatment Tables 6, 6A, 4 or 8, decompress the tenders on the Air/Oxygen schedule in the Air Decompression Table having a depth exactly equal to or deeper than the maximum depth attained during the treatment and a bottom time equal to or longer than the total elapsed time since treatment began
If death occurs after leaving the initial treatment depth on Treatment Tables 6 or 6A, decompress the tenders at 30 fsw/min to 30 fsw and have them breathe oxygen at 30 fsw for the times indicated If death occurs after leaving the initial treatment depth on Treatment Tables 4 or 8, or after beginning treatment on Treatment Table 7 at 60 fsw, have the tenders decompress by continuing on the treatment table as written, or consult NEDU for a decompression schedule customized for the situation at hand. If neither option is possible, follow the original treatment table to 60 fsw. At 60 fsw, have the tenders breathe oxygen for 90 min in three 30-min periods separated by a 5-min air break. Continue decompression at 50, 40 and 30 fsw by breathing oxygen for 60 min at each depth. Ascend between stops at 30 fsw/min. At 50 fsw, breathe oxygen in two 30-min periods separated by a 5-min air break. At 40 and 30 fsw, breathe oxygen for the full 60-min period followed by a 15-min air break. Ascend to 20 fsw at 30 fsw/min and breathe oxygen for 120 min. Divide the oxygen time at 20 fsw into two 60-min periods separated by a 15 min air break. When oxygen breathing time is complete at 20 fsw, ascend to the surface at 30 fsw/min. Upon surfacing, observe the tenders carefully for the occurrence of decompression sickness. |
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Impending Natural Disasters or Mechanical Failures
(20-10.2) |
1. If deeper than 60 feet, go immediately to 60 feet.
2. Once the chamber is 60 feet or shallower, put all chamber occupants on continuous 100 percent oxygen. Select the Air/Oxygen schedule in the Air Decompression Table corresponding to the maximum depth attained during treatment and the total elapsed time since treatment began. 3. If at 60 fsw, breathe oxygen for period of time equal to the sum of all the decompression stops 60 fsw and deeper in the Air/Oxygen schedule, then continue decompression on the Air/Oxygen schedule, breathing oxygen continuously. If shallower than 60 fsw, breathe oxygen for a period of time equal to the sum of all the decompression stops deeper than the divers current depth, then continue decompression on the Air/Oxygen schedule, breathing oxygen continuously. Complete as much of the Air/Oxygen schedule as possible. 4. When no more time is available, bring all chamber occupants to the surface (try not to exceed 10 feet per minute) and keep them on 100 percent oxygen during evacuation, if possible. 5. Immediately evacuate all chamber occupants to the nearest recompression facility. If no symptoms occurred after the treatment was aborted, follow Treatment Table 6. |
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Fluids intake for pulmonary DCS
(20‑11.1.2) |
Fluids should be administered to all individuals suffering from DCS unless suffering from the chokes (pulmonary DCS). Oral fluids (half-strength glucose and electrolyte solutions) are acceptable if the diver is able to tolerate them.
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Primary and Secondary Emergency Kits
(20-12.1) |
The primary emergency kit contains diagnostic and therapeutic equipment that is available immediately when required. This kit shall be inside the chamber during all treatments. The secondary emergency kit contains equipment and medicine that does not need to be available immediately,
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AED and ACLS requirements
(20-12.2) |
All diving activities/commands shall maintain an automated external defibrillator
All commands with chambers that participate in area bends watch shall maintain those drugs recommended by the American Heart Association for ACLS. |
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Tender O2 TT5 requirements
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Tender breathes 100 percent O2 during ascent from the 30-foot stop to the surface. If the tender had a previous hyperbaric exposure in the previous 18 hours, an additional 20 minutes of oxygen breathing is required prior to ascent
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Tender O2 TT6 requirements
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Tender breathes 100 percent O2 during the last 30 min. at 30 fsw and during ascent to the surface for an unmodified table or where there has been only a single extension at 30 or 60 feet. If there has been more than one extension, the O2 breathing at 30 feet is increased to 60 minutes. If the tender had a hyperbaric exposure within the past 18 hours an additional 60-minute O2 period is taken at 30 feet.
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Tender O2 TT6A requirements
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Tender breathes 100 percent O2 during the last 60 minutes at 30 fsw and during ascent to the surface for an unmodified table or where there has been only a single extension at 30 or 60 fsw. If there has been more than one extension, the O2 breathing at 30 fsw is increased to 90 minutes. If the tender had a hyperbaric exposure within the past 18 hours, an additional 60 minute O2 breathing period is taken at 30 fsw.
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Tender O2 TT9 requirements
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Tender breathes 100 percent O2 during last 15 minutes at 45 feet and during ascent to the surface regardless of ascent rate used.
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Pressure test required on chamber when?
(21-6.2) |
initially installed, at 2-year intervals thereafter, and after a major overhaul or repair
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Signs and Symptoms of Shock
(5B-4.1) |
-Respiration shallow, irregular, labored
-Eyes vacant (staring), lackluster, tired-looking -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) |
-Loss of judgment
-Lack of concentration -Lack of muscle control Inability to perform delicate or skill-requiring tasks -Drowsiness -Weakness -Agitation -Euphoria -Loss of consciousness |
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Symptoms of Hypercapnia
(3‑5.2.2) |
-Increased breathing rate
-Shortness of breath, sensation of difficult breathing or suffocation (dyspnea) -Confusion or feeling of 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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Symptoms of Hypoxia
(3‑5.1.2) |
-Loss of judgment
-Lack of concentration -Lack of muscle control Inability to perform delicate or skill-requiring tasks -Drowsiness -Weakness -Agitation -Euphoria -Loss of consciousness |
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Symptoms of Hypercapnia
(3‑5.2.2) |
-Increased breathing rate
-Shortness of breath, sensation of difficult breathing or suffocation (dyspnea) -Confusion or feeling of 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 Decompression-
no decompression stops |
Observe on surface for 1 hour
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Management of Asymptomatic Omitted Decompression-
stop at 20-30 FSW |
Less than 1 min- Return to depth of stop. Increase stop time by 1 min. Resume decompression according to original schedule.
1 to 7 min - Use Surface Decompression Procedure Greater than 7 min Treatment Table 5 if 2 or fewer SurDO2 periods, Treatment Table 6 If more than 2 SurDO2 periods No chamber Return to depth of stop. Multiply 30 and/or 20 fsw air or O2 stop times by 1.5 |
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Management of Asymptomatic Omitted Decompression-
Deeper than 30 fsw |
- Treatment Table 6
- If no chamber Descend to depth of first stop. Follow the schedule to 30 fsw. Switch to O2 at 30 fsw if available. Multiply 30 and 20 fsw air or O2 stops by 1.5 |
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Management of Asymptomatic Omitted Decompression-
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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electronic, bimetallic, alcohol, or liquid crystal thermometers.
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