Advanced Dive Medicine Assumed Test Questions Flashcards
Sea Urchins have a Venomous stinging Organ Called
Gobiferous Pedicellariae, or stinging spine
The most deadly Octopus
Blue Ringed -No Antivenin
Steroids for Dive treatment
Not recommended, worsens CNS injuries
Lidocaine for Dive treatment
Used for AGE, not recommended in DCS.
Fluids for DCS II Patients
Fluids are contradicted when patient is suffering from the chokes
Urine output for patient
.5cc Hour
Drip Chamber on Descent/Ascent
Chamber Fills on decent/Emptys on ascent
D5W Electrolyte IV fluid
Use @ DMO’s Discretion due to cerebral and pulmonary edema.
Chest tube site
2nd or 3rd intercostal space midclavicular line over the affected lung
Chest tube secondary site
5th intercostal space anterior axillary line. Hand under the armpit
Endotracheal intubation ventilation stop time, Vent time
Do not stop for more than ::30, Ventilate for ::60
Endo tracheal Bradycardia
Can slow during intubation from vagus nerve stimulation
Inside tender responsibilities
Releaseing Door Latchs, Communicateing with outside personnel, Provideing first Aid, Administering treatment gas @ depth, Normal assistance, Donning/doffing hearing protection, Paitient is lying down to permit adequate blood flow.
NON Diving Personnel as IT
Completion of Navy IT PQS, Current Physical Exam, Conform to Navy physical standards, Passed a pressure test
Clinical HBO2 Therapy TX Disorders
Cyanide poisoning, Carbon Monoxide, Gas gangrene, Smoke inhalation, Necrotizing soft tissue infection, Iatrogenic embolism, thermal burns, chronic refractory osteomyelitis, intracranial abscess.
Rationale for HBO in bubble disorders
Increase in pressure decrease in bubble size, Reduce bubble by maximizing inert gas off-gassing gradient, Increase O2 to the tissues.
Candidate Pressure test
Navy Certified Chamber -60 FSW for :10, Must remain on site for :15 and facility for 1 hour
Re compression Chamber extinguishing means
Wetted towels, Bucket of water, Pressurized water extinguisher, Hand held hose system, suppression deluge system
Abort Procedure - Natural Disaster - Mechanical failure
Ascend to 60FSW AT 30 FPM, All on O2, Follow AIR/O2 Table for max depth breathing O2 continuously, Breath 02 for the sum of deeper deco stops prior to deco from that depth, No more time bring chamber to surface @ 10FPM on 100 O2. NO symptoms follow TT6 asap.
Post Chamber Treatment observation time
TT-5 - 2 hours TT-6 6 hours , All others at DMO discretion
Treatments administered more than 5 days require
1 day break
Re-compression at altitude Gauge’s
Zero gauges
First Decompression Theories published by
J.s Haldane theory of half times
Maximum chamber co2 sev at depths
.78 30fsw
.53 60fsw
.25 165fsw
IV Drip rate
75/100 cc per hour
Urinary catheterization
Inability to void, bladder distension, unconscious, monitor fluids
Chamber fire hazard 02 levels
19-25% never allow to exceed 25%
Pressure Test Chamber
2 years, initial installation, overhaul, repair
Chamber categories
1 - :5 2- 1:00 3- 6:00
Post TX TT-5 / TT-6 Observation times
TT5 2:00/ TT6 6:00 remain @ Facility, DMO modify if less than :30 from chamber
Tender Post TX observation
1:00 @ facility, TT4/7/8 1:00 away for 24:00
Patient flying after treatment
DMO concurrence 72:00 wait after DCS/AGE resolution
Tender Flying after treatment
TT 5/6/6A/1A/2A/3 24:00, TT 4/7/8 72:00
Aircraft pressurization for EVAC
1 ATA, stay below 1000 FT altitude
Return to diving No Symptoms/Symptoms
30 days/ Residual symptoms obtain Waiver
Tender S/I after treatment before diving
18:00 NoD/ 24:00 Deco TT 4/7/8 48:00
Chamber Co2/O2 SEV max
1.5 SEV C02 / 25% 02
Vent ACFM Requirements for Air/02
2 Paitient/4 tender Air / 12.5 Paitient/ 25 Tender
Chamber Temperature unlimited time all treatments
85 and below
Chamber Temperature 85-94
6:00 / TT5/6/6A/1A/9
Chamber Temperature 95-104
2:00 / TT5/9
Patient Sleep/Eat/Drink
Sleep except when breathing 02 deeper than 30FSW, Eat anytime
Modify a treatment
DMO OIC/CO permission/ or UMO 16U0 16U1
Purpose of HBO
Decrease Bubble, restart blood flow, relieve local pressure, Reduce bubble by maximizeing inert off gassing gradient, Allow time to reabsorb bubble, Increase 02 to injured tissue
Anaphylactic Shock
caused by severe allergic reaction
Cardiogenic Shock
Caused by heart attack poor heart function
Hemorrhagic Shock (hypovolemic)
Loss of large amount of blood
Neurogenic
Nerve paralysis, spinal cord injury, uncontrolled dilation of blood vessels
Psychogenic
Caused by fright or fear
Stages of Shock
Compensated (correcting itself), Decompensated (body no longer able to compensate) irrevesible - celldamage liver kidney failure and permanent damage
Extremity Strength 5
Normal - equal bilateral strength
Extremity Strength 4
Mild Weakness - able to resist slight force
Extremity Strength 3
Moderate Weakness - Resist gravity but not examiner
Extremity Strength 2
Sever Weakness - Able to contract muscle but not overcome gravity
Extremity Strength 1
Profound Weakness - Flicker or trace muscle movements
Extremity Strength 0
Paralysis - No motion
Cranial Nerve 1
Olfactory - Smell/Taste - rarely tested
Cranial Nerve 2
Optic - Reading focusing/ Fields
Cranial Nerve 3
Occulomotor - Movement in the eye/Pupil dilation
Cranial Nerve 4
Trochlear - cross eyed
Cranial Nerve 5
Trigeminal - Facial sense, chewing
Cranial Nerve 6
Abducens - Lateral eye movement
Cranial Nerve 7
Facial - Whistle, close eyes, wrinkle
Cranial Nerve 8
Auditory- Hearing, balance
Cranial Nerve 9
Glossopharyngeal - Gag - not normally tested
Cranial Nerve 10
Vagus - Roof of mouth, vocal cords - Heart beat
Cranial Nerve 11
Spinal accessory - neck shoulder shrug
Cranial Nerve 12
Hypoglossal - Movement of tongue
Coordination tests
Walk/Gait, Romberg, Heel toe, Rapid alternateing movement, finger to nose, Heel shin
6 parts of a neuro
Mental status, Coordination, Cranial nerves, Motor/strength, Sensory, DTR
Pulseless Diver HBO Treatment
Unavailable press to 60FSW CPR, :10 AED/ACLS CPR until arrival on surface, :20 deco @ 30FPM administer AED/ACLS. Regains vitals press to 60, remains pulsless continue CPR until pronounced dead. Never recompress a pulseless diver.
Symptomatic Omitted D
Less than 50FSW TT6, 51 FSW or deeper 60 or DOR TT6A not to exceed 165, Greater than 165 TT8. DMO ASAP TT5 not acceptable
CNS O2 toxicity First sign
Off 02, symptoms subside,:15min, resume POI
CNS 02 toxicity second sign or first is a convulsion
Off 02, symptoms subside/relaxed and breathing normal, deco 10FSW 1 FPM, resume @ POI
CNS 02 toxicity symptoms after ascent 10FSW
Contact DMO before resuming 02
Loss of 02 during Treatment
:15, maintain depth, fixed resume 02 @ POI, :15-2:00 MAINTAIN DEPTH RESUME @ poi MAX EXTENSIONS,
Greater than 2:00 switch to comparable air table, SX worsen TT4 for greater depth
Treatment authorization for HBO therapy waiver
BUMED Code M3B42
Reoccurence 60FSW or shallower
Back to 60FSW, 3 :20 02 periods relieved TT6, Not TT7 or DOR not to exceed 165fsw
Reoccurence 60FSW or deeper
go to DOR not to exceed 165,Air for :30, No more time needed TT6A, more time TT4.
TT5 use
Complete neuro- no deficits,DCS I, Asymptomatic Omitted D, Relief W/:10 or a TT6
TT6 use
AGE, Cutis,Type II, Type I :10 no relief, Symptomatic/Asymptomatic :20 no relief switch to TT6A