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Basic Dive Medicine > Basic Dive Medicine 1 > Flashcards

Basic Dive Medicine 1 Flashcards

1
Q

Respiratory System

A

-System which brings air into and out of the body providing a constant supply of O2 while removing CO2

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2
Q

Upper Respiratory Tract

A

1) Contains:
- Nose
- Naval Cavity
- Maxillary / Frontal Sinuses
- Larynx
- Trachea
2) Carries air to and from the lungs and filters, moistens, and warms air during every inhalation

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3
Q

Lower Respiratory Tract

A

1) Lungs Contain:
- Bronchi
- Bronchioles
- Alveoli
2) Bronchioles provide passage of air to the alveoli
3) Alveoli (Small Air Sacs at the end of the Bronchioles) Present a large are for gas exchange
- O2 -> CO2

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4
Q

Mechanics of Breathing

A

1) As air enters the lungs it comes into contact with alveolar surface
2) O2 is diffused from alveolar air into the alveolar capillary beds of the lungs due to higher pp of O2

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5
Q

Gas Exchange

A

1) The higher ppO2 in the alveoli pushes the O2 into the solution in the blood which has a lower ppO2
2) The elevated ppCO2 in the plasma is divers into the lungs where the CO2 is at a lower partial pressure.
- Daltons Law and Henrys Law
3) Oxygenated blood enters circulation and approaches the body cells
4) Diffusion takes place in the opposite direction than it did in the lungs
5) Cells utilize the oxygen during metabolism and produce CO2 as a by product

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6
Q

The Circulatory System

A
  • A closed system that brings Oxygen, Nutrients, and Hormones to every cell and tissue
  • Carries away CO2, Waste Chemicals, and Heat
  • Heat : is very important to maintaining homeostasis
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7
Q

Blood Vessels

A

1) Piping system that carries blood from the heart to all tissues and organs of the body
2) Arteries
3) Veins
4) Capillaries
5) Blood

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8
Q

Arteries

A
  • Carries blood AWAY from the heart
  • Oxygenated
  • Diminish in size and increase in number as they get further from the heart
  • Smallest are called ARTERIOLES
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9
Q

Veins

A
  • Blood vessels that RETURN blood to the heart

- They increase in size and diminish in number as they return to the heart

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10
Q

Capillaries

A
  • Smallest and most numerous of the blood vessels

- Capillary beds are the site of the O2/CO2 exchange

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11
Q

Blood

A
  • Carries O2 to every tissue in the body
  • made of Red Blood Cells (RBC) and Plasma
  • Hemoglobin: Protein that on RBC that attracts O2
  • Plasma: fluid portion of blood that carries CO2 from tissues to lungs
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12
Q

Mechanics of Circulation

A

1) Veins carry blood from body tissues through the capillary bloods of the lungs
2) Blood is then pumped from the heart through the capillary beds of the lungs
3) Blood is then pumped through the arteries and back to the capillaries
4) At the capillaries the RBCs give off their O2 to the cells and the plasma picks up the CO2 that is produced (cellular metabolism)
5) The blood continues on to the venous system eventually back tot he heart

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13
Q

Veins carry blood where?

A
  • From body tissues to the right side of the heart

- Veins are O2 POOR and CO2 RICH

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14
Q

Hemoglobin takes up what?

A

O2 is taken up by hemoglobin

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15
Q

Plasma gives off what?

A

CO2 is given off by the plasma

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16
Q

What type of blood returns to the LEFT side of the heart?

A

O2 rich blood returns to the LEFT side of the heart

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17
Q

Characteristics of CO Poisoning

A

1) Colorless, Odorless, Tasteless Gas

2) Produced as a result of incomplete combustion of hydrocarbons

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18
Q

Sources of CO

A

1) Internal Combustion Engines

2) Industrial Pollution (chemical Smog)

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19
Q

How does CO enter breathing media?

A

1) Compressor intake downwind of exhaust
2) **Improper compressor lubricants in compressor
3) Faulty air compressor system

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20
Q

What is the mechanism of CO poisoning?

A

CO binds with the hemoglobin in RBC’s, displacing and blocking the pick of O2

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21
Q

What are the Factors of CO Absorption?

A

1) Divers Physical activity level
- harder youre breathing more CO being taken into system
2) Ambient levels of CO
3) Duration of exposure

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22
Q

Symptoms of CO Poisonings

A

1) Headache / Band of tightness across the forehead (think Twighlight)
2) Pounding in the temples
3) Nausea / Vomiting
4) Unconsciousness
- May be the 1st symptom!!

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23
Q

When do CO poisoning symptoms usually occur?

A

Most likely to occur during ASCENT or ON THE SURFACE

-as size of CO molecules increase (PP) symptoms will occur more rapidly

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24
Q

Post dive for CO Poisoning

A

1) Dive profile and history
2) multiple divers involved
- most likely all tanks filled from same contaminated source
3) metallic taste in the air
4) suspect contaminated breathing media

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25
Q

CO Poisoning Treatment

A

1) remove patient from CO exposure
2) 100% O2 by mask
3) Medical / UMO eval
4) Hyperbaric oxygen therapy may be necessary

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26
Q

Hypoxia

A

Condition that arises as a result of diminished O2 to the tissues
-AKA O2 Deficiency

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27
Q

Causes of O2 Deficiency (Hypoxia)

A

1) Air supply failure
2) Diver loses his mouthpiece
3) Airway obstruction of restriction
4) Insufficient O2 in divers breathing media
- If O2 falls below .16ATA (16%) hypoxia symptoms will begin to occur on surface
5) Utilization of available O2 within confined space
- Hyperbaric Chamber
- Inadequate ventilation space

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28
Q

Symptoms of Hypoxia (O2 Deficiency)

A

1) Lack of Concentrations
2) Lack of muscle control
3) Inability to perform delicate of skill requiring tasks
4) Drowsiness
5) Weakness
* 6) Cyanosis (Blue)
7) Dizziness / Lightheaded
* 8) Euphoria
9) Loss of consciousness
* 10) Agitation

29
Q

Treatment of Hypoxia (O2 Deficiency)

A

1) In water : Perform Emergency Procedures (EP) for rigs
2) On surface: Administer 100% O2 by mask
- CPR if necessary (don’t try to administer in water)
- Hospital / Medical UMO

30
Q

Hypercapnia (CO2 Tox)

A

1) Abnormally high level of CO2 in tissues
2) Most prevalent of all abnormal gas problems experienced in diving
3) If CO2 production increases (ex. exercise) ventilation must also increase

31
Q

Causes of Hypercapnia

A

1) Skip breathing
2) Excessive work at depth
3) Over-Breathing dive apparatus capacity

32
Q

Symptoms of Hypercapnia (CO2 tox)

A

1) Headache- worse after exposure to O2 (AKA sitting on surface)
2) Shortness of breath (air hunger)
3) Increased respiratory rate
4) Increased heart rate
5) Feeling of euphoria (usually before passing out)
6) Confusion
7) Unconsciousness (May be 1st symptom)
8) Drowsiness

33
Q

When does Hypercapnia usually occur?

A

Symptoms became apparent at depths deeper than 120 FSW when divers attempt heavy work loads

34
Q

Prevention of Hypercapnia (CO2 Poisoning)

A

1) follow pre dive check procedures
2) moderate work pace
3) avoid skip breathing
4) avoid over breathing dive apparatus

35
Q

Treatment of Hypercapnia (CO2) IN WATER

A

1) Ventilate helmet (surface supplied)
2) notify buddy
3) decrease work
4) breath normally (stop skip breathing)
5) abort dive
6) seek medical attention

36
Q

Treatment of Hypercapnia (CO2) ON SURFACE

A

1) Remove divers apparaturs
2) 100% O2 by mask
3) Transport to medical for UMO eval

37
Q

Nitrogen Narcosis

A

Narcotic feeling caused by the effects of inert gasses on the Central Nervous System (CNS)

38
Q

Air Diving Limitations

A

1) Oxygen toxicity (Primary Reason)

2) Nitrogen Narcosis (Secondary Reason)

39
Q

Benefits of Helium when diving?

A

1) Helium acts as a diluent will eliminate nitrogens effect during deep dives
- Helium Oxygen moistures should be considered for any dive in excess of 150 FSW
- N2 is an inert gas

40
Q

Narcotic Effect of N2

A

1) At an increasing PPN2, N2 exerts a progressive depression on the CNS
2) Similar to action of general anesthetics
3) Likened to the effect of narcotics
4) Called “narcosis”

41
Q

Working Principals of N2 Narcosis

A

1) Progressive with increased pressure
2) Not progressive with increasing time at depth
3) Begins at 130 FSW
- Very prominent at 200 FSW
- Becomes disabling at deeper depths
4) Each individual has different susceptibility
5) Reversible with deceasing pressure
6) Tolerance with time at depth
7) Resolves with ascent above depth of onset within 1 minute

42
Q

How to “train” for N2 Narcosis

A
  • Experienced divers may be reasonably productive and safe at depths where others fail
  • Familiar with extent to which nitrogen narcosis impairs their performance
  • Experience and frequent exposure may enable air dives as deep as 180-200 FSW
43
Q

Symptoms of N2 Narcosis

A

1) Generally intellectual capacities are more severely affected than manual abilities
2) Progresisve narcosis is very similar to progressive alcohol intoxication
3) loss of judgement or skill
4) False feeling of well being
5) Lack of concern for job or safety (HM2 Wilbur Chamber dive)
- disregard for personal safety (Sunfish lady)
6) Apparent stupidity
7) Inappropriate laughter
8) tingling or vague numbness of lips, gums, and legs

44
Q

Tolerance to N2 Narcosis

A

1) Work up dives
2) Acclimation
3) Implies and actual mental change in the divers ability to handle repeated exposure to nitrogen

45
Q

Prevention of N2 Narcosis

A

1) Avoidance of excessive ppN2
- Limit depth
2) Pre-dive planning
- Job determines depth
- depth determines mixture (does not apply to scuba)

46
Q

Treatment of N2 Narcosis

A

1) Ascend above the depth onset

- Normally resolves in 1 minute

47
Q

O2 Toxicity

A

Two Types

1) Central Nervous System O2 Toxicity (CNS)
2) Pulmonary O2 Toxicity
- Dependent Upon both pp and exposure time

48
Q

CNS O2 Toxicity

A

1) Excessive PP of O2
- Normally not encountered until ppO2 reaches or exceeds 1.3-1.6 ATA (daltons law)
2) Factors affecting the risks of CNS O2 Toxicity
- Individual Susceptibility
- CO2 Retention
- Exercise
- Immersion in Water
- Depth
- Intermittent exposure
- equipment / absorption failure
- Inadequate ventilation of rig

49
Q

Symptoms of O2 Toxicity

A

VENTID-C
V: Vision (blurred, tunnel vision)
E: Ears (ringing or roaring)
N: Nausea / Vomiting (may be intermittent)
T: Twitching / Tingling (appears in lips / facial muscles or muscles of the extremities)
I: Irritability (change in behavior)
D: Dizziness (includes clumsiness, incoordination, and fatigue)
C: Convulsions (May be first sign)

50
Q

Treatment for O2 Toxicity

A

In Water
- conduct EPs for diving apparatus
During Chamber Operations
-Treat IAW US Navy Diving Manual Ch 17

51
Q

Pulmonary O2 Toxicity

A

1) Occurs during or after Lung Exposures to increased ppO2
- Long O2 treatments in hyperbaric chambers
2) Symptoms after long exposure
- Coughing
- Burning
- Dyspnea (shortness of breath)

52
Q

What is dyspnea?

A

Shortness of breath

53
Q

Hypothermia

A

-Occurs when core temp drops below 98 Degrees

54
Q

Potential Heat Loses in Diving

A

1) Water immersion
- lose body heat 25x faster
2) Air temperature and wind

55
Q

External Insulation to prevent Heat Loss in Diving

A

1) Neoprene wet suit
- Used for protection of water temps below 80 Degrees
2) Variable Volume Dry Suit (VVDS) / Hot water suit
- Water temps below 40 Degrees

56
Q

Mild Hypothermia Symptoms

A

1) Complains of cold
2) Shivering
3) Slurred Speech
4) Poor Judgement

57
Q

Treatment for Mild Hypothermia

A

1) Passive Rewarming
- Dry clothes
- warm environment
- blankets
- hot soup / drink
- Avoid caffeine / alcohol/ tobacco
2) Active rewarming
- warm shower / bath
- place in very warm space
- thermal angel (iv hand warmer)

58
Q

Moderate Hypothermia Symptoms

A

Can Be Life Threatening of heat loss is not stopped

1) Apathy
2) Mild Confusion
3) Slurred Speech
4) Uncontrollable Shivering
5) Ashen (gray) appearance
6) slow pulse

59
Q

Treatment of Mild Hypothermia

A

1) Active External Re Warming
- Warm Bath (100-110)
- When rewarming in bath leave extremities out of water
- rewarding extremities can shunt cold blood to heart and cause shock
- adequate rewarming is achieved once patient is sweating
- Use warm shower only if left in wet suit (evaporation)
- Seek Medical Help
2) Passive external re warming
- prevent further heat loss
- warm clothes
- allow body to recover on its own

60
Q

Sevre Hypothermia Symptoms

A

Handle gently (cardiac arrest is possible)

1) Motor Functions Impaired
2) Shivering stops
- Body has entered decompensation (no longer trying to fix problems)
3) Irregular heartbeat / shallow pulse
4) Decreased / loss of consciousness

61
Q

Severe Hypothermia Treatment

A

1) Passive external re warming only
2) prevent exertion
3) prevent further heat loss
4) no oral intake
5) seek medical help

62
Q

Considerations for Hypothermia

A
  • Hypothermia requires prompt attention (But is emergency in “slow motion”)
  • Rescuer has time to think before acting PBTA
63
Q

What is the cause of SHALLOW WATER BLACKOUT?

A

Hyperventilation

  • decreases CO2 levels in blood prolonging body urge to breathe
  • while urge to breathe has been decreased O2 is still metabolized at the same rate
  • creates state of hypoxia
  • diver loses consciousness before feeling urge to breathe=
64
Q

Shallow Water Blackout Treatment

A

1) remove victim from water
2) CPR if needed
3) administer 100% O2 by mask
4) Transport to medical

65
Q

Near Drowning

A

Suffocation by immersions in a liquid with victim being successfully resuscitated

66
Q

Near Drowning Causes

A

1) Overexertion / Panic / Inability to cope with rough water / exhaustion
2) The effects of heat loss due to cold water
3) All victims must be evaluated by UMO
- Possibility of pneumonia (fluid in lungs) largest risk

67
Q

Symptoms of Near Drowning

A

1) Unconsciousness
2) Increased respiratory rate
3) shortness of breath
4) coughing with frothy or blood tinged sputum
5) Cyanosis (blue)
6) Distress

68
Q

Near Drowning Treatment

A

1) In Water rescue requires ventilation alone
- Open / Maintain Airway
- Check Breathing
- Provide 5 rescue breaths (kiss the breath in)
- Provide in water rescue breathing (1 breath every 6 seconds)
2) Victim Should be assumed to be in cardiac arrest (if no response from rescue breaths)
3) Once on stable platform placed in supine position
4) Victim may only need ventilation
5) CPR / BLS as required
- ABC Method
6) 100% O2 with AED on chest
7) Prepared for possible vomiting and suctioning of airway
8) Transport to nearest hospital even if possibly showing signs for DCS

Basic Dive Medicine (1 decks)

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