Us Navy Dive Manual Chapter 20 Rev 6 Change A

Front 1

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?

Back 1

Arterial gas embolism

Front 2

What are your actions for a diver who surfaces unconscious and recovers when exposed to fresh air?

Back 2

Perform a neurological evaluation to rule out arterial gas embolism.

Front 3

Victims of near-drowning who have no neurological symptoms should be carefully evaluated by a DMO for what disorder?

Back 3

Pulmonary aspiration

Front 4

What are some signs and symptoms of AGE?

Back 4

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.

Front 5

What is the treatment for AGE?

Back 5

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.

Front 6

What conditions must not be overlooked when treating a stricken diver for an arterial gas embolism?

Back 6

Symptoms of subcutaneous/mediastinal emphysema, pnuemothorax and/or pnuemopericardium may also be present. In all cases of AGE the possible presence of these associated conditions should not be overlooked.

Front 7

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?

Back 7

120 minutes, Treatment Table 4. If a shift to a TT-4 is contemplated a DMO must be consulted.

Front 8

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.

Back 8

10 minutes

Front 9

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?

Back 9

Compress the diver to 60 feet, continue CPR and attempt to contact a DMO

Front 10

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.

Back 10

20 minutes - Current data indicates that successful restoration of a perfusing rhythm after 20 minutes of cardiac arrest with only CPR is unlikely. AVOID RECOMPRESSING A PULSELESS DIVER who has failed to regain vital signs.

Front 11

What are the symptoms Type I decompression sickness?

Back 11

Joint pain (musculoskeletal or pain-only symptoms) and symptoms involving the skin (cutaneous symptoms), or swelling and pain in lymph nodes.

Front 12

What is the most common symptom of decompression sickness?

Back 12

Joint pain

Front 13

Describe the characteristics of Type 1 joint pain.

Back 13

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.

Front 14

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?

Back 14

Type II decompression sickness

Front 15

What type of pain only symptoms may indicate spinal cord involvement and treated as Type II DCS?

Back 15

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).

Front 16

What Type I symptoms do not require treatment?

Back 16

Itching and skin rash

Front 17

What is the most common skin manifestation of Type I decompression sickness?

Back 17

Itching

Front 18

What is mottling or marbling of the skin treated as (cutis marmorata)?

Back 18

Type II decompression sickness

Front 19

Describe how pain and swelling of the lymph nodes responds to recompression treatment.

Back 19

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.

Front 20

What is the treatment for Type I DCS?

Back 20

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

Front 21

What are you actions if a full neurological exam is not completed before initial recompression for treatment of Type I DCS?

Back 21

Treat as a Type II symptom

Front 22

Type II, or serious, symptoms are divided into what three categories?

Back 22

Neurological, inner ear (staggers), and cardiopulmonary (chokes)

Front 23

What are the nuerological symptoms of Type II DCS?

Back 23

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.

Front 24

Inner ear decompression sickness (staggers) occurs most often during what type of diving?

Back 24

Helium-oxygen diving and during decompression when the diver switched from breathing helium-oxygen to air.

Front 25

What are the symptoms of Inner Ear Decompression Sickness?

Back 25

Tinnitus (ringing in the ears), hearing loss, vertigo, dizziness, nausea, and vomiting.

Front 26

Inner ear decompression sickness should be differentiated from what other two disorders with similar symptoms?

Back 26

-Inner ear barotrauma
-Nuerological decompression sickness involving the cerebellum. Typically rapid involuntary eye movement (nystagmus) is not present in cerebellar DCS.

Front 27

What is Chokes (cardiopulmonary symptoms)?

Back 27

Profuse intravascular bubbling in the lungs which may due to congestion of the lung circulation.

Front 28

What are the symptoms of Chokes?

Back 28

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.

Front 29

Since most symptoms of Type II DCS and AGE are the same, how do you differentiate diagnosis between the two?

Back 29

Time of onset. AGE usually occurs within 10 minutes of surfacing

Front 30

What is the treatment for Type II DCS?

Back 30

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.

Front 31

In rare instances, decompression sickness may develop in the water while the diver is undergoing decompression. What would the predominant symptom usually be?

Back 31

Joint pain

Front 32

At what point during decompression will in-water decompression sickness is most likely to appear?

Back 32

At the shallow decompression stops just prior to surfacing. Some cases, however, have occurred during ascent to the first stop or shortly thereafter.

Front 33

If a diver has had an uncontrolled ascent and has any symptoms, what is your course of action?

Back 33

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.

Front 34

For altitude decompression sickness, if only joint pain was present but resolved before reaching one ata from altitude, what is your course of action?

Back 34

Treated with two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation

Front 35

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?

Back 35

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.

Front 36

What are the primary objectives of recompression treatment?

Back 36

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

Front 37

What is the descent rate for TT 1A, 2A, 3, 4, 5, 6, 6A, 7, and 9? What about TT- 8?

Back 37

20 feet per minute for except TT-8 which is as fast as tolerable

Front 38

When beginning a treatment table, at what point do you put the patient on oxygen?

Back 38

Upon reaching a treatment depth of 60 fsw or shallower

Front 39

When treating Type I pain on an air treatment table, what is the determining factor for what treatment table you will use?

Back 39

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.

Front 40

What is a Treatment Table 3 used for?

Back 40

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.

Front 41

When transporting how should he be trasported (postition, monitoring, considerations etc..)

Back 41

-Kept lying supine (horizontally), never head down
-Kept warm
-Monitor ABC's
-Pay special attention to the possibilty of mutiple conditions and underlying issues
-If needed, start IV prior to transport

Front 42

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?

Back 42

The patient should still be recompressed as if the original symptom(s) were still present

Front 43

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?

Back 43

Less than 1,000 feet, use of an EEHS should be considered if available

Front 44

To transport a patient, if available, always use aircraft that can be pressurized to ______ atmosphere.

Back 44

One atmosphere

Front 45

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.

Back 45

12–24 hours

Front 46

When may an uncertified chamber be used?

Back 46

In an emergency, if in the opinion of a qualified Chamber Supervisor (DSWS Watchstation 305), it is safe to operate.

Front 47

What must be done prior to recompressing a diver in the water as a treatment alternative because no chamber is available?

Back 47

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.

Front 48

What protocol do you follow for in-water recompression using air?

Back 48

Follow Air Treatment Table 1A as closely as possible.
-Do not use SCUBA unless you have to, maintain constant comms, keep at least one diver with patient at all times, plan UBA/cylinder shifts, have ample tenders.
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.

Front 49

What protocol do you follow for in-water recompression using oxygen?

Back 49

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.

Front 50

What should the occurrence of Type II symtoms after in-water recompression be considered as?

Back 50

It is an ominous sign and could progress to severe, debilitating decompression sickness. It should be considered life threatening

Front 51

What is a Treatment Table 5 used for?

Back 51

1. Type I DCS (except cutis marmorata) when a complete neurological examination has revealed no abnormality. Repeat nuero upon arrival at 60'
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

Front 52

What is a Treatment Table 6 used for?

Back 52

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

Front 53

What is a Treatment Table 6A used for?

Back 53

To treat arterial gas embolism or decompression symptoms when severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw.

Front 54

What is a Treatment Table 4 used for?

Back 54

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. A DMO shall be consulted before the shift to a TT-4

Front 55

What is the minimum and maximum time that can be spent at 165’ or depth of relief on a TT-4?

Back 55

Minimum 30 minutes and maximum 120 Minutes

Front 56

How long are the O2 periods once you get to 60 fsw on a TT-4 or TT-7?

Back 56

25 minutes oxygen, 5 minute air break

Front 57

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.

Back 57

4 hours, 2 hours

Front 58

When using Treatment Table 7, a minimum of ____________ should be spent at 60 feet.

Back 58

12 hours

Front 59

When using a TT-7, normally, _______ oxygen breathing periods are alternated with _____hours of continuous air breathing.

Back 59

Four oxygen breathing periods, 2 hours

Front 60

When may a patient sleep and eat during a treatment in the chamber?

Back 60

The patient may sleep anytime except when breathing oxygen deeper than 30 feet. While sleeping vital signs should be monitored as patients condition dictates. Food may be taken at any time by chamber occupants

Front 61

What is a Treatment Table 8 used for?

Back 61

For treating deep uncontrolled ascents when more than 60 minutes of decompression have been missed.

Front 62

What is a Treatment Table 9 used for?

Back 62

1. Residual symptoms remaining after initial treatment of AGE/DCS
2. Selected cases of carbon monoxide or cyanide poisoning
3. Smoke inhalation

Front 63

Treatment Table 9, is a hyperbaric oxygen treatment table providing ______ minutes of oxygen breathing at ________ feet. What is the tenders O2 requirement

Back 63

90 minutes, 45 feet. Tender breathes O2 for the last :15 and during ascent to the surface

Front 64

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? Who approves these treatments?

Back 64

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. Authorization from BUMED Code M3B42 shall be obtained prior to treatment.

Front 65

What is the emergency, minimum and optimum manning levels for chamber operations?

Back 65

-Emergency: 2 (Chamber Sup and inside tender
-Minimum: 3 (Chamber sup, inside tender, outside tender)
-Optimum: 4 (Chamber sup, inside tender, outside tender #1, comms and logs)

Front 66

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.

Back 66

19 percent and 25 percent

Front 67

Chamber carbon dioxide level should not be allowed to exceed what level during a treatment table?

Back 67

1.5 percent SEV (11.4 mmHg)
0.78% at 30'
0.53% at 60'
0.25% at 165'

Front 68

When may CO2 absorbent be used beyond the expiration date when used in a recompression chamber?

Back 68

When the chamber is equipped with a CO2 monitor. Bags shall be double bagged and labled with the expiration date on the container.

Front 69

A chamber temperature below ______ °F is always desirable, no matter which treatment table is used.
What are the allowable ranges for treatments in the chamber?

Back 69

85°F
Temp in F Time allowed TT allowed
Under 85 Unlimited All
85-94 6 hours 1A,5,6,6A,9
95-104 2 hours 5, 9
Above 104 Intolerable None
*Never deviate from prescribed limits unless qualified medical personal can evaluate risk to gain

Front 70

What are the allowbale thermometers in the chamber?

Back 70

-Electronic
-Bimettalic
-Alcohol
-Liquid crystal
Never use thermometers containing mercury

Front 71

How much and what type of fluid shall be given to the patient over the course of a Treatment Table 5 or 6?

Back 71

One to two liters of water, juice, or a non carbonated drink.

Front 72

When should patients be considered for IV fluids?

Back 72

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.

Front 73

If IV is given to a patient, at what rate should be kept dripping at?

Back 73

75 to 100 cc/hour

Front 74

What type of IV fluid is recommended to be used during recompression therapy?

Back 74

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.

Front 75

How much and what type of urine output means adequate fluid is being given? What is the concern if urine output is low?

Back 75

When clear colorless urine output is at least 0.5cc/kg/hr is an indication that adequate fluid is being provided and the patient is hydrated. The bladder could be paralyzed due to DCS type II, if that is the case admister a urinary catheter filling the ballon with liquid, not air.
*1 cc (cubic centimeter) = 1 ml (milliliters)

Front 76

What are the chamber ventilation requirements in regards to treatments?

Back 76

Ventilation is required for chambers without carbon dioxide scrubbers and atmospheric analysis. Ventilation rates are as follows:
- 2 acfm for each resting occupant (patient)
- 4 acfm for each active occupant (tender)

Front 77

What are the requirements for double lock recompression chambers access to patients during treatment?

Back 77

Access to occupants is the availability to pass in items such as food, water, and drugs and the ability to pass out urine, exrement, and trash. Never attempt a treatment longer than a TT-6 unless there is access to occupants.
TT-4, 7, and 8 require double lock chambers.

Front 78

What are the responsibilities of the Inside Tender?

Back 78

First rule is DO NO FURTHER HARM
-Releasing the door latches after seal is made
-Communicating with outside personnel
-Providing first aid as required by the patient
-Administering treatment gas to the patient
-Providing normal assistance to patient as required
-Ensure hearing protection is wore (1/16" hole)
-Ensure patient is positioned to permit blood flow

Front 79

What are the requirments for use of a Non-Diver as an Inside Tender?

Back 79

-NAVEDTRA 43910 Inside Tender PQS
-Current diving physical exam
-Conformance to Navy physical standards
-Diver candidate pressure test

Front 80

Are there any requirements for using specialized medical care? I.e. surgeon, respiratory therapist, etc.

Back 80

Emergency situations that require specialized medical care should always have the best medical personnel. These emergency exposures require no special prerequisites but a qualified Inside Tender is required in the chamber to handle any system requirements

Front 81

What is the required surface interval for Inside Tenders during consecutive treatments?

Back 81

18 hours- TT 1A, 2A, 3, 5, 6, and 6A
48 hours- TT 4, 7, and 8
*Within 18 hours for 5, 6, and 6A requires requires additional O2 time for tenders
Wait times for TT 1A, 2A, 3, 4, 7, and 8 shall be strictly observed.

Front 82

When are the high oxygen mixtures used, what are the depth limits and ranges of gases?

Back 82

Gas mixtures are highly recommended when at treatment depths deeper than 60', the treatment gases will provide a PPO2 between 1.5 and 3.0 ata at depth.
0-60': 100% O2 (1.00-2.82 ata PPO2)
61'-165': 50/50 HEO2 or N2O2 (1.42-3.00 ata PPO2)
166'-225' : 64/36 HEO2 Only (2.17-2.81 ata PPO2)

Front 83

CNS oxygen toxicity is unlikely in resting individuals at chamber depths of _____' and shallower and very unlikely at ______' or shallower. However patients with severe _________ DCS or AGE may be abnormally sensitive to CNS oxygen toxicity.

Back 83

50', 30', Type II

Front 84

What are the procedures for handling CNS oxygen toxicity in the chamber?

Back 84

1st symptom- Off O2, wiat :15 after all symptoms have subsided and resume at point of interruption.
2nd symptom/Convulsion- Off O2, after all symptoms have subsided and px is relaxed and breathing normally ascend 10' at 1' per minute. Resume at POI.
3rd symptom/2nd convulsion- Off O2, consult DMO

Front 85

When could you see pulmonary oxygen toxicity during treatments? What are the symptoms and how do you treat it?

Back 85

TT 4, 7, and 8 or with repeated TT 5, 6, 6A.
Symptoms include end inspiratory discomfort, progressing to substernal burning and severe pain on inspiration.
- For a patient responding well to treatment, off O2 consult DMO
- For if patient is still improving or symptoms worsen when removed from O2 modify oxygen periods as needed with consultation from DMO

Front 86

What are your procedures for loss of oxygen during treatment?
-Repaired within :15
-Repaired after :15 but before 2 hours
-Cannot be restored in 2 hours

Back 86

-Repaired within :15: Maintain depth, resume at POI
-Repaired :15 to 2 hours: Maintain depth, resume at POI using max O2 extensions for TT 5, 6, and 6A. No compensation needed for TT 4, 7, and 8.
-If it cannot be restored in 2 hours switch to a comparable air table at current depth if at 60' or shallower. Do not exceed 1 fpm between stops, if symptoms worsen or deeper than 60' is needed switch to a TT-4, consult with DMO.

Front 87

What special considerations must be adhered to when performing treatments at altitude?

Back 87

-Zero depth gauges prior to treatment
-Tenders locking in for brief periods shall adhere to the diving at altitude procedures
-Tenders remaining in the chamber for the full duration of treatment must adhere to the tender O2 breathing requirements for provided altitudes. If tender O2 requirement exceeds prescribed stop time at 30' extend stop time to meet requirement, If stop time cannot be extended observe tender on surface for one hour. Requirements pertain to all tenders regardless of equalibration, Contact NEDU for guidance on tables other than 5, 6, 6A.

Front 88

What is the required surface interval for Inside Tenders from treatment to diving?
*TT- 5, 6, 6A, 1A, 2A, or 3
*TT- 4, 7, and 8

Back 88

-TT- 5, 6, 6A, 1A, 2A, or 3
No "D": 18 hour SI
"D": 24 hour SI
-TT- 4, 7, and 8
"D" or No "D": 48 hour SI

Front 89

How long must you observe a patient and Inside Tender after treatment for recurrence of symptoms?

Back 89

-2 hours for patients treated on a TT-5
-6 hours for patients who have been treated for type II or required a TT-6 for type I symptoms.
Times may be shortened upon recommendation of a DMO provided the patient can return within :30
Do not release patient without consulting a DMO
All px should remain with in :60 of chamber for 24 hrs.
Inside tender should remain in vicinity of chamber for one hour and for TT-4, 7, 8 within :60 for 24 hours.

Front 90

What is the required surface interval before flying after treatments?
-Patients
-Tenders

Back 90

Patients
-Residual symptoms: concurrence of DMO.
-Complete relief: 72 hours
Tenders
-TT 5, 6, 6A, 1A, 2A, 3: 24 hours
-TT 4, 7, 8: 72 hours

Front 91

If emergency transportation is required following a treatment what considerations must be met?

Back 91

-Only done on recommendation of DMO
-Aircraft prussureized to 1 ata, or unpressurized aircraft flown at less than 1,000'
-Breathe 100% O2 during transport
- Use EEHS to maintain 1 ata, if available

Front 92

What are the requirements and considerations for treatment of residual symptoms?

Back 92

-DMO must be consulted, NEDU or NDSTC if needed
-Do not delay, > than one week benifit is not likely
-Treat residual sx until no further benifit is noted.
-Discontinue if no benifits following 2 consecutive tx
-Persistent type II: Daily TT6 or 2 a day w/ TT 5 or 9
-Pulmonary O2 tox following long/repeat exposures
-5 days consecutive tx requires at least 1 day break

Front 93

Discuss the guidelins and requirements for returning to diving following recompression treatment.

Back 93

-Type I: 7 days if successful completion fo treatment and apporval by DMO
-AGE/Type II: 30 days after initial tx and diagnosis by DMO, if the tx is successful and no neurological deficits persist. If sx persists beyond initial tx BUMED waiver for a return to diving is required, refer to MANMED for info.

Front 94

Who can modify treatments?

Back 94

Only DMOs with sub specialty codes 16U0 or 16U1 with the concurrence of the CO or OIC.

Front 95

What is the procedure for a death during treatment?

Back 95

Consult DMO before aborting any treatment!
-If aborting following initial recompression to 60, 165, 225 decompress on the Air/O2 schedule. Air "D" table.
-If death occurs after leaving initial tx depth on TT 6/6A decompress the tenders at 30 fpm to 30' and them fulfil tender O2 requirements, including O2 30' to the surface at a rate of 1 fpm.
-If death occurs after leaving initial treatment depth on a TT 4/8 or beginning a TT-7 continue the table as prescribed or consult NEDU for customized schedule.

Front 96

What is the procedure for impending natural disasters or mechanical failure?

Back 96

1. If deeper than 60', go directly to 60'
2. Place all occupants on O2 at 60', select the Air/O2 schedule appropriate for max depth obtained and total elapsed time since treatment began.
3. Perform the sum of all missed decompression stops deeper than current depth at the current depth on O2. Decompress on the Air/O2 schedule as perscribed, completing as much as possible.
4. When time has run out, ascend to surface on oxygen at a rate of 10 fpm (try not to exceed) and keep occupants on 100% O2 during evacuation.
5. Immediatly evacuate to nearest chamber, if no symptoms occured use TT-6 as a minimum.

Front 97

What is adjunctive therapy and how is adjunctive therapy guidance seperated?

Back 97

Adjunctive therapy refers to any treatment that is used in conjunction with another to increase the chance of cure, or to increase the first treatment's efficacy. In other words, adjunctive therapy acts as an aid to the primary treatment. It is seperated into two sections
-Decompression sickness
-Arterial gas embolism

Front 98

What are the guidelines administering drug therapy?

Back 98

Drug therapy shall be administered only after consultation with a DMO by qualified Inside Tenders adaquately trained and capable of administering prescribed medications.

Front 99

Discuss the following adjunctive therapy for decompression sickness?
-Surface O2
-Fluids
-Anticoagulants
-Asprin/non-steroidal anti-inflammatory drugs
-Steroids
-Lidocaine
-Enviornmental temperature

Back 99

-Surface O2: Use at 15 lpm for up to 12hrs
-Fluids: Mouth or IV unless chokes present. 50/50 glucose/electrolyte by mouth . Avoid fluid overloading
-Anticoagulants: Do not use, exception is lower extremity weakness/paralysis due to deep venous thrombosis (DMV). Refer to dive manual
-Asprin/non-steroidal anti-inflammatory drugs: Not recommended due to worsening hemorrhage in spinal cord or inner ear DCS
-Steroids: May worsen outcome of CNS injury
-Lidocaine: Not recommened
-Enviornmental temps: Do not allow px to become hot

Front 100

Discuss the following adjunctive therapy for Arterial Gas Embolism?
-Surface O2
-Lidocaine
-Fluids
-Anticoagulants
-Asprin/non-steroidal anti-inflammatory drugs
-Steroids

Back 100

-Surface O2: Use at 15 lpm for up to 12hrs
-Lidocaine: Useful for tx of AGE, refer to Dive Manual
-Fluids: Special caution must be taken to not overload px with fluids, use urinary cathater for unconsciousnes
-Anticoagulants: Do not use, exception is lower extremity weakness/paralysis due to deep venous thrombosis (DMV). Refer to dive manual
-Asprin/non-steroidal anti-inflammatory drugs: Not recommended for use with AGE
-Steroids: May worsen outcome of CNS injury

Front 101

Discuss the requirements for primary and secondary medical kits.

Back 101

Primary- Contains diagnostic therapeutic equipment. The primary kit shall be inside the chamber during all treatments
Secondary- Contains equipment and medicine that does not need to be immediately available, but can be locked-in when required.
Both kits shall have a tamper seal and be inventoried every time it is opened and unopened kits shall be inventoried quarterly.

Front 102

What are the steralization requirements for sterile equipment in the medical kits?

Back 102

Unless adaquately sealed against increased pressure (i.e. vacuum packed) sterile supplies should be re-sterilized after each pressure exposure, or if not exopsed, at experation date.

Front 103

Who can modify the medical kit requirements?

Back 103

The responsible Diving Medical Officer or Diving Medical technician to support local needs. The precribed primary and secondary medical kit inventories shall be used as minimum equipment

Front 104

In regards to a recompression chamber facility what are the requirements for a portable Monitor-Defibrillator (AED) and Advanced Cardiac Life Support (ACLS) Drugs and Equipment?

Back 104

-All commands shall maintain an AED and if a DMO is assigned augment a fully capable monitor defibrillator.
-All commands that participate in area bends watch shall mainatin ACLS drugs recommended by the American Heart Association. In, addition, medications to treat for anaphylaxis shall be maintained for a minimum of one patient.

Front 105

An assessment of the patient must be made within ___ minutes. If a stricken diver remains pulseless after ___ minutes, termination of resuscitation may be considered.

Back 105

20 minutes for both

Front 106

A DMO must be consulted before commiting to what two treatment tables?

Back 106

TT-4 and TT-7

Front 107

What is the ascent rate for all treatment tables?

Back 107

TT- 1A, 2A, 3, 4, 5, 6: 1 fpm
TT-6A: 3 fpm for 165' to 60' followed by 1 fpm 60' to 0'
TT-9: 20 fpm, but can be slowed to 1 fpm if needed

Front 108

Describe the following in regards to a TT-5
1.Total time
2.Total periods at 60 and 30
3.Extensions allowed

Back 108

1. :135 (2 hours 15 minutes)
2. 2 :20 O2 periods @ 60', 1 :20 O2 period @ 30'
* Can be extended 2 :20 O2 periods @ 30', air breaks not required between 30' O2 periods or prior to ascent to the surface.

Front 109

Describe the following in regards to a TT-6
1.Total time
2.Total periods at 60 and 30
3.Extensions allowed

Back 109

1. :285 (4 hours 45 minutes)
2. 2 :20 O2 periods @ 60', 1 :20 O2 period @ 30'
Extentions include
2 :60 O2 periods @ 30'
and/or
2 :20 O2 periods @ 60'
*Air break not required prior to ascent to surface.

Front 110

Describe the following in regards to a TT-6A
1.Total time
2.Total periods at 60 and 30
3.Extensions allowed

Back 110

1. :350 (5 hours 50 minutes)
2. 1 :30 stop at depth of relief NTE 165', 3 :20 O2 periods @ 60', 2 :60 O2 period @ 30'
Extentions include
2 :60 periods @ 30'
and/or
2 :20 periods @ 60'
*Air break not required prior to ascent to surface..

Front 111

What are the tender oxygen breathing requirements for a TT-5 from surface to 2499' elevation?

Back 111

The only time a tender must breathe O2 at 30' on a TT-5 is when there has been previous hyperbaric exposure within 18 hours.
TT-5 :20
TT-6/6A :60
In addition breathe oxygen from 30' to the surface.

Front 112

What are the tender oxygen breathing requirements for a TT-6 from surface to 2499' elevation?

Back 112

Up to one extension @ 30' or 60'= :30
More than one extension= :60
Previous hyperbaric exposure within 18 hours=
TT-5 :20
TT-6/6A :60
Add the required time to be spent on oxygen at :30, in addition breathe oxygen from 30' to the surface.

Front 113

What are the tender oxygen breathing requirements for a TT-6A from surface to 2499' elevation?

Back 113

Up to one extension @ 30' or 60'= :60
More than one extension= :90
Previous hyperbaric exposure within 18 hours=
TT-5 :20
TT-6/6A :60
Add the required time to be spent on oxygen at :30, in addition breathe oxygen from 30' to the surface.