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72 Cards in this Set
- Front
- Back
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As a basic rule, any diver who has obtained a breath of compressed gas from any source at depth, whether from diving apparatus or from a diving bell, and who surfaces unconscious, loses consciousness, or has any obvious neurological symptoms within 10 minutes of reaching the surface, must be assumed to be suffering from what diving disorder?
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Arterial gas embolism
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What are your actions for a diver who surfaces unconscious and recovers when exposed to fresh air?
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Perform a neurological evaluation to rule out arterial gas embolism.
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Victims of near-drowning who have no neurological symptoms should be carefully evaluated by a DMO for what disorder?
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Pulmonary aspiration
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What are some signs and symptoms of AGE?
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Near immediate onset of dizziness, paralysis or weakness in the extremities, large areas of abnormal sensation (paresthesias), vision abnormalities, convulsions or personality changes. During ascent, the diver may have noticed a sensation similar to that of a blow to the chest. The victim may become unconscious without warning and may stop breathing. Additional symptoms of AGE include: Extreme fatigue, difficulty in thinking, vertigo, nausea and/or vomiting, hearing abnormalities, bloody sputum, loss of control of bodily functions, tremors, loss of coordination, numbness.
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What is the treatment for AGE?
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Initial compression to 60 fsw. If symptoms are improved within the first oxygen breathing period, then treatment is continued using Treatment Table 6. If symptoms are unchanged or worsen, assess the patient upon descent and compress to depth of relief (or significant improvement), not to exceed 165 fsw. Complete 30 min period breathing air or treatment gas on Table 6A.
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You are treating for AGE at 60 feet, symptoms are unchanged or worsen, you decide to compress to depth of relief (or significant improvement), not to exceed 165 fsw. You complete a 30 min period on Table 6A and determine more time is needed at depth. What is the maximum time you can spend there and what treatment table will you come out on?
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120 minutes, Treatment Table 4
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For a diver with no pulse or respirations, if a qualified provider with the necessary equipment (i.e., AED) can administer the potentially lifesaving therapies within ______ minutes, the stricken diver should be kept at the surface until a pulse is obtained.
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10 minutes
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If defibrillation is not available and a Diving Medical Officer (DMO) is not present, what should the Diving Supervisor do for a diver with no pulse or respirations?
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Compress the diver to 60 feet and continue CPR and attempt to contact a DMO
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You’ve compressed a pulseless diver to 60 feet while performing CPR. If defibrillation becomes available within _____ minutes, the pulseless diver shall be brought to the surface at 30 fpm and defibrillated when appropriate on the surface.
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20 minutes - Current data indicate that successful restoration of a perfusing rhythm after 20 minutes of cardiac arrest with only CPR is unlikely.
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What are the symptoms Type I decompression sickness?
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Joint pain (musculoskeletal or pain-only symptoms) and symptoms involving the skin (cutaneous symptoms), or swelling and pain in lymph nodes.
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What is the most common symptom of decompression sickness?
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Joint pain
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Describe the characteristics of Type 1 joint pain.
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The pain may be mild or excruciating. The most common sites of joint pain are the shoulder, elbow, wrist, hand, knee, and ankle. The characteristic pain of Type I decompression sickness usually begins gradually, is slight when first noticed and may be difficult to localize. It may be located in a joint or muscle, may increase in intensity, and is usually described as a deep, dull ache. The pain may or may not be increased by movement of the affected joint, and the limb may be held preferentially in certain positions to reduce the intensity (so-called guarding). The hallmark of Type I pain is its dull, aching quality and confinement to particular areas. It is always present at rest and is usually unaffected by movement.
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Any pain occurring in the abdominal and thoracic areas, including the hips, should be considered as symptoms arising from spinal cord involvement and treated as what?
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Type II decompression sickness
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What type of pain only symptoms may indicate spinal cord involvement and treated as Type II DCS?
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1. Pain localized to joints between the ribs and spinal column or joints between the ribs and sternum.
2. A shooting-type pain that radiates from the back around the body (radicular or girdle pain). 3. A vague, aching pain in the chest or abdomen (visceral pain). |
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What Type I symptoms do not require treatment?
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Itching and skin rash
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What is the most common skin manifestation of Type I decompression sickness?
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Itching
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What is mottling or marbling of the skin treated as?
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Type II decompression sickness
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Describe how pain and swelling of the lymph nodes responds to recompression treatment.
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It may provide prompt relief from pain. The swelling, however, may take longer to resolve completely and may still be present at the completion of treatment.
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What is the treatment for Type I DCS?
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Recompress to 60 feet. If symptoms resolve in the first 10 minutes, treat on TT-5. If symptoms are not resolved within the first 10 minutes, treat on a TT-6
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What are you actions if a full neurological exam is not completed before initial recompression for treatment of Type I DCS?
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Treat as a Type II symptom
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Type II, or serious, symptoms are divided into what three categories?
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Neurological, inner ear (staggers), and cardiopulmonary (chokes)
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What are the symptoms of Type II DCS?
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These symptoms may be the result of involvement of any level of the nervous system. Numbness, paresthesias (a tingling, pricking, creeping, “pins and needles,” or “electric” sensation on the skin), decreased sensation to touch, muscle weakness, paralysis, mental status changes, or motor performance alterations are the most common symptoms. Disturbances of higher brain function may result in personality changes, amnesia, bizarre behavior, lightheadedness, lack of coordination, and tremors. Lower spinal cord involvement can cause disruption of urinary function. Tinnitus (ringing in the ears), hearing loss, vertigo, dizziness, nausea, and vomiting.
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Inner ear decompression sickness (staggers) occurs most often during what type of diving?
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Helium-oxygen diving and during decompression when the diver switched from breathing helium-oxygen to air.
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One category of Type II DCS is Inner Ear Decompression Sickness. What is it commonly known as?
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Staggers
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What are the symptoms of Inner Ear Decompression Sickness?
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Tinnitus (ringing in the ears), hearing loss, vertigo, dizziness, nausea, and vomiting.
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What is Chokes?
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Profuse intravascular bubbling in the lungs
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What are the symptoms of Chokes?
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May start as chest pain aggravated by inspiration and/or as an irritating cough. Increased breathing rate is usually observed. Symptoms of increasing lung congestion may progress to complete circulatory collapse, loss of consciousness, and death if recompression is not instituted immediately. Careful examination for signs of pneumothorax should be performed on patients presenting with shortness of breath.
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Since most symptoms of Type II DCS and AGE are the same, how do you differentiate diagnosis between the two?
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Time of onset. AGE usually occurs within 10 minutes of surfacing
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What is the treatment for Type II DCS?
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Initial compression to 60 fsw. If symptoms are improved within the first oxygen breathing period, then treatment is continued on a Treatment Table 6. If severe symptoms (e.g. paralysis, major weakness, memory loss) are unchanged or worsen within the first 20 minutes at 60 fsw, assess the patient during descent and compress to depth of relief (or significant improvement), not to exceed to 165 fsw. Treat on Treatment Table 6A. To limit recurrence, severe Type II symptoms warrant full extensions at 60 fsw even if symptoms resolve during the first oxygen breathing period.
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In rare instances, decompression sickness may develop in the water while the diver is undergoing decompression. What is the predominant symptom usually be?
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Joint pain
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At what point during decompression will in-water decompression sickness is most likely to appear?
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At the shallow decompression stops just prior to surfacing. Some cases, however, have occurred during ascent to the first stop or shortly thereafter.
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If a diver has had an uncontrolled ascent and has any symptoms, what is your course of action?
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He should be compressed immediately in a recompression chamber to 60 fsw. Conduct a rapid assessment of the patient and treat accordingly.
If the diver surfaced from 50 fsw or shallower, 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. Consultation with a Diving Medical Officer should be obtained as soon as possible. For uncontrolled ascent deeper than 165 feet, the diving supervisor may elect to use Treatment Table 8 at the depth of relief, not to exceed 225 fsw. |
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For altitude decompression sickness, if only joint pain was present but resolved before reaching one ata from altitude, what is your course of action?
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Treated with two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation
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For altitude decompression sickness, if other symptoms or if joint pain symptoms are present after return to one ata, what is your course of action?
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Treat on the appropriate treatment table, even if the symptoms resolve while in transport. Individuals should be kept on 100 percent oxygen during transfer to the recompression facility.
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What are the primary objectives of recompression treatment?
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1. Compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow
2. Allow sufficient time for bubble resorption 3. Increase blood oxygen content and thus oxygen delivery to injured tissues |
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How long must you observe a patient after treatment for recurrence of symptoms?
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2 hours for pain-only symptoms
6 hours for serious symptoms Do not release patient without consulting a DMO |
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What is the descent rate for treatment tables 5, 6, 6A, 4, or 7?
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20 feet per minute
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When beginning a treatment table, at what point do you put the patient on oxygen?
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Upon reaching a treatment depth of 60 fsw or shallower
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When treating Type I pain on an air treatment table, what is the determining factor for what treatment table you will use?
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Use Air Treatment Table 1A if pain is relieved at a depth less than 66 feet. If pain is relieved at a depth greater than 66 feet, use Treatment Table 2A.
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What is a Treatment Table 3 used for?
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Treatment of serious symptoms where oxygen cannot be used. Use Treatment Table 3 if symptoms are relieved within 30 minutes at 165 feet. If symptoms are not relieved in less than 30 minutes at 165 feet, use Treatment Table 4.
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Always have the patient breathe 100 percent oxygen during transport, if available. If symptoms of decompression sickness or arterial gas embolism are relieved or improve after breathing 100 percent oxygen, what should you do?
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The patient should still be recompressed as if the original symptom(s) were still present
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If a patient is moved by helicopter or other unpressurized aircraft, the aircraft should be flown as low as safely possible, lower than what altitude is preferred?
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Less than 1,000 feet
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To transport a patient, if available, always use aircraft that can be pressurized to ______ atmosphere.
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One atmosphere
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Recompression in the water should be considered an option of last resort, to be used only when no recompression facility is on site, symptoms are significant and there is no prospect of reaching a recompression facility within a reasonable timeframe of ____ - ____ hours.
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12–24 hours
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When may an uncertified chamber be used?
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In an emergency, if in the opinion of a qualified Chamber Supervisor (DSWS Watchstation 305), it is safe to operate.
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What must be done prior to recompressing a diver in the water as a treatment alternative because no chamber is available?
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The stricken diver should begin breathing 100 percent oxygen immediately (if it is available). Continue breathing oxygen at the surface for 30 minutes before committing to recompress in the water. If symptoms stabilize, improve, or relief on 100 percent oxygen is noted, do not attempt in-water recompression unless symptoms reappear with their original intensity or worsen when oxygen is discontinued. Continue breathing 100 percent oxygen as long as supplies last, up to a maximum time of 12 hours. The patient may be given air breaks as necessary. If surface oxygen proves ineffective after 30 minutes, begin in-water recompression.
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What protocol do you follow for in-water recompression using air?
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Follow Air Treatment Table 1A as closely as possible.
If the depth is too shallow for full treatment according to Air Treatment Table 1A: 1. Recompress the patient to the maximum available depth. 2. Remain at maximum depth for 30 minutes. 3. Decompress according to Air Treatment Table 1A. Do not use stops shorter than those of Air Treatment Table 1A. |
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What protocol do you follow for in-water recompression using oxygen?
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1. Put the stricken diver on the UBA and have the diver purge the apparatus at least three times with oxygen.
2. Descend to a depth of 30 feet with a standby diver. 3. Remain at 30 feet, at rest, for 60 minutes for Type I symptoms and 90 minutes for Type II symptoms. Ascend to 20 feet even if symptoms are still present. 4. Decompress to the surface by taking 60-minute stops at 20 feet and 10 feet. 5. After surfacing, continue breathing 100 percent oxygen for an additional 3 hours. 6. If symptoms persist or recur on the surface, arrange for transport to a recompression facility regardless of the delay. |
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What is a Treatment Table 5 used for?
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1. Type I DCS (except for cutis marmorata) symptoms when a complete neurological examination has revealed no abnormality.
2. Asymptomatic omitted decompression 3. Treatment of resolved symptoms following in-water recompression 4. Follow-up treatments for residual symptoms 5. Carbon monoxide poisoning 6. Gas gangrene |
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What is a Treatment Table 6 used for?
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1. Arterial gas embolism
2. Type II DCS symptoms 3. 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 4. Cutis marmorata 5. Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation 6. Asymptomatic omitted decompression 7. Symptomatic uncontrolled ascent 8. Recurrence of symptoms shallower than 60 fsw |
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What is a Treatment Table 6A used for?
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To treat 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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What is a Treatment Table 4 used for?
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Is used when it is determined that the patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw, while on a TT-6A
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What is the minimum and maximum time that can be spent at 165’ or depth of relief on a TT-4?
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Minimum 30 minutes and maximum 120 Minutes
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How long are the O2 periods once you get to 60 fsw on a TT-4 or TT-7?
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25 minutes oxygen, 5 minute air break
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Both the patient and tender on a TT-4 must breathe oxygen for at least __________ (eight 25-minute oxygen, 5-minute air periods), beginning no later than _____________ before ascent from 30 feet is begun.
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4 hours, 2 hours
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When using Treatment Table 7, a minimum of ____________ should be spent at 60 feet.
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12 hours
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When using a TT-7, normally, _______ oxygen breathing periods are alternated with _____hours of continuous air breathing.
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Four oxygen breathing periods, 2 hours
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When may a patient sleep during a treatment in the chamber?
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The patient may sleep anytime except when breathing oxygen deeper than 30 feet.
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What is a Treatment Table 8 used for?
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For treating deep uncontrolled ascents when more than 60 minutes of decompression have been missed.
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What is a Treatment Table 9 used for?
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1. Residual symptoms remaining after initial treatment of AGE/DCS
2. Selected cases of carbon monoxide or cyanide poisoning 3. Smoke inhalation |
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Treatment Table 9, is a hyperbaric oxygen treatment table providing ______ minutes of oxygen breathing at ________ feet.
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90 minutes, 45 feet
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In addition to individuals suffering from diving disorders, U.S. Navy recompression chambers are also permitted to conduct emergent hyperbaric oxygen (HBO2) therapy to treat individuals suffering from what other medical disorders?
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Cyanide poisoning, carbon monoxide poisoning, gas gangrene, smoke inhalation, necrotizing soft-tissue infections, or arterial gas embolism arising from surgery, diagnostic procedures, or thoracic trauma.
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What is the minimum and optimum manning levels for chamber operations?
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Minimum 3 (Chamber sup, inside tender, outside tender)
Optimum 4 (Chamber sup, inside tender, outside tender #1, comms and logs) |
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If the chamber is equipped with a life-support system so that ventilation is not required and an oxygen analyzer is available, the oxygen level should be maintained between _____ percent and _____ percent.
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19 percent and 25 percent
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Chamber carbon dioxide level should not be allowed to exceed what level during a treatment table?
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1.5 percent SEV (11.4 mmHg)
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When may CO2 absorbent be used beyond the expiration date when used in a recompression chamber?
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When the chamber is equipped with a CO2 monitor
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A chamber temperature below ______ °F is always desirable, no matter which treatment table is used.
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85°F
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How much fluid intake over the course of a Treatment Table 5 or 6 is usually sufficient?
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One to two liters
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When should patients be considered for IV fluids?
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Patients with Type II symptoms, or symptoms of arterial gas embolism. Stuporous or unconscious patients should always be given IV fluids, using large-gauge plastic catheters.
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If IV is given to a patient, at what rate should be kept dripping at?
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75 to 100 cc/hour
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What type of IV fluid is recommended to be used during recompression therapy?
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Isotonic fluids (Lactated Ringer’s Solution, Normal Saline)
Avoid solutions containing glucose (Dextrose) if brain or spinal cord injury is present. Intravenously administered glucose may worsen the outcome. |
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How much urine output means adequate fluid is being given?
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When urine output is at least 0.5cc/kg/hr
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