chamber sup

Question 1

Who is authorized to modify a recompression treatment? which treatment tables require DMO concurrence?

Answer 1

UMO Code 16UO, 16U1

4, 7, require DMO

Question 2

A pilot started to have a 6 out of 10 pain scale in his right knee mid flight and he had complete relief prior to landing. what is your

Diagnosis?
Course of Action?
Treatment/ Post-Treatment considerations?

Answer 2

Diagnosis: altitude DCS type 1

Course of Action: since the pilot only had joint pain and had complete relief before landing treat with 2 hours of 100% O2 and observe for 24 hours.

treatment: 2 hours of 100% 02 and observe for 24 hours

Question 3

describe in detail a patient’s return to diving requirements post treatment.

Answer 3

Divers diagnosed with any POIS or DCS shall be referred to a DMO for clearance prior to returning to diving.

In most cases, a waiver of the physical standards will be required from BUPERS via BUMED.

Question 4

can a TT-5 be extended?

Answer 4

Yes, TT5 can be extended up to 2 additional 02 periods at 30ft

Question 5

patients that have been treated for DCS or AGE should not fly for _____ hours after treatment

Answer 5

72 hours

Question 6

Can TT-6 be extended?

Answer 6

• 2 25 min periods at 60ft (20 mins on O2 with 5 min air breaks)
• 2 additional 75 min periods at 30ft (60 mins on O2 with 15 min air breaks)
• Or both

Question 7

during treatments all chamber occupants may breathe 100% O2 at depths of ___ feet or shallower without locking in additional personnel.

Answer 7

45 feet

tenders hold bibs to face

Question 8

If a pulseless diver with no respiration is brought to your chamber, how long should you wait before beginning recompression and why?

Answer 8

DO NOT RE-COMPRESS A PULSELESS DIVER.

• if the diver is pulseless and not breathing ACLS is a higher priority than recompression. (ACLS) advanced cardiac life support
• CPR must begin immediately and an AED should be placed on the victim as soon as possible.
• If the pulseless diver regains vital signs continue, or begin, transport to the nearest critical care facility prior to recompression.

Question 9

What are the three primary objectives of recompression treatment?

Answer 9

R-R-R

Recompress the bubble

Resorption of bubble

Repair- Increase O2 pp to damaged tissue

Question 10

What is the treatment of severe mediastinal emphysema?

Answer 10

shallow recompression may be beneficial. Re­ compression should only be carried out upon the recommendation of a Undersea Medical Officer who has ruled out the occurrence of pneumothorax.

Question 11

what are the procedures for CNS O2 tax in the chamber?

If symptoms of CNS oxygen toxicity develop again or if the first symptom is a convulsion, take the follow action:

Answer 11

• Remove O2 bibs and breath chamber air
• wait 15 mins after all symptoms have subsided resume breathing at point of interruption for 5,6, 6a

Remove>decompress>Resume>contact DMO

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.

If another oxygen symptom occurs after ascending 10 fsw, contact a Undersea Medical Officer to recommend appropriate modifications to the treatment schedule.

Question 12

If a pulseless diver with no respirations is compressed and ACLS arrives explain the procedures for administering ACLS. (depth is 60ft)

Answer 12

If ACLS arrives, surface the chamber at 30fpm (2 mins) and apply the AED (not authorized at depth)

Let the qualified team try and revive the patient.

stay with the patient to the hospital

Question 13

What is the minimum number of personnel required to conduct normal and emergency recompression chamber operations?

Answer 13

minimum: 3-chamber sup, inside tender, outside tender
ideal: 7- DO, MDV, UMO, Chamber sup, IT, OT, Com/logs
emergency: 2- Chamber sup, IT

Question 14

you are treating a patient on TT-5 for type 1 in his right elbow. At 32’ on ascent from 60-30, he tells you that his right elbow is starting to hurt again. COA?

Answer 14

Treat as symptoms of recurrence

• press back down to 60ft
• complete 3 20 min O2 breathing
• decompress TT-6

Question 15

What % levels must the chamber 02 and C02 be maintained during a treatment?

Answer 15

O2- 19-25%

CO2- Below 1.5 SEV

Below .78 @30
Below .53 @60
Below .25 @165

Question 16

When would you conduct a neuro prior to treatment?

Answer 16

Type 1 dcs (expect for cutis marmorata)

Dcs type 2 minor numbness not spreading

No deterioration

Question 17

Explain in detail the procedures for loss of O2 during a treatment in the following situations.

If repair can be completed within 15 mins

if repair can be completed after 15 mins but before 2 hours

Answer 17

with in 15 mins:

• Maintain depth until repair is completed.
• After O2 is restored, resume treatment at point of interruption.

after 15 less than 2 hours:

• Maintain depth until repair is completed.
• After O2 is restored: If original table was Table 5, 6, or 6A, complete treat- ment with maximum number of O2 extensions.

Question 18

list 5 times a TT-5 may be used

Answer 18

• Type I DCS (except for cutis marmorata)
• Asymptomatic omitted decompression
• Carbon monoxide poisoning
• Gas gangrene
• Follow-up treatments for residual symptoms

Question 19

Define the following definitions

• Immediately available chamber
• ready chamber
• emergency chamber

Answer 19

Immediately- a navy certified chamber available with in 5 mins. may be extended to 7 mins with CO auth.

Ready- avalible with in 1 hour.

Emergency- with in 6 hours

Question 20

Tenders on TT 5, 6, 6A, 1A, 2A, or 3 should have a minimum of a ____ -hour surface interval before no-D diving and a minimum of a ____ - hour surface interval before dives requiring decompression stops. Tenders on TT 4, 7, and 8 should have a minimum of a ____- hour surface interval prior to diving.

Answer 20

• 18 hours
• minimum of a 24 hour
• 48hours

Question 21

Can non diving personnel be used as an inside tender?

Answer 21

Non-diving medical personnel must obtain -a current diving physical exam,

• conform to Navy physical standards,
• pass the diver candidate pressure test.

Question 22

What type of chamber shall be painted IAW Recompression chamber paint process instruction (NAVSEA-00C3-PI-001)

Answer 22

NAVSEA carbon steel chambers

Question 23

describe the recompression treatment procedure for an AGE and there is no 02 available. (not getting it back)

Answer 23

complete decompression in the chamber on 50% nitrogen 50% oxygen (preferred) or on air. If 50% nitrogen 50% oxygen is available, multiply the remaining oxygen time by two to obtain the equivalent chamber decompression time on 50/50. Air breaks are not required when breathing 50/50.

Question 24

During a treatment What should the oral fluid intake be?

Answer 24

One to two liters of water, juice, or non-carbonated drink, over the course of a Treatment Table 5 or 6, is usually sufficient.

Question 25

what is Pulmonary/ CNS O2 Toxicity? which is most likely to develop? what are the symptoms?

Answer 25

Pulmonary O2- Low O2 toxicity, Substernal burning, severe pain on inspiration (inhale), more likely to develop on long TT- 4,7

CNS O2- High O2 toxicity, 1.3 ata (wet) 2.4 ata (dry), VEN(twitching)IDC

CNS O2 is more likely to develop on shorter TT.

CNS 02 VENDTIDC, Pulmonary O2 CBS (cough severe, Breathing shortness of breath, substernal chest pain)

Question 26

when is the use of a TT-6A mandatory?

Answer 26

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

Question 27

What are the duties and responsibilities of the Chamber supervisor?

Answer 27

-Communicating with personnel inside the chamber.

-minimum manning levels for conducting recompression
treatment (Table 17-1).

-Ensuring every member of the chamber team is thoroughly familiar with
all recompression procedures.

• Undersea Medical Officer is contacted at the earliest opportunity during treatment and before release of any patient from the treatment facility.
• Make sure everything is LOGGED
• Ensuring details related to the assessment and treatment of the patient (e.g. condition prior to treatment, time and depth of complete relief, patient vital signs) are thoroughly documented in the recompression chamber log IAW section 5-5 and the command dive bill.
• Tracking bottom time and the decompression profiles of personnel locking in and out of the chamber.
• Ensuring the decompression profiles of persons locking in and out of the chamber are logged in the chamber log.

Question 28

explain direct and indirect bubble effects.

Answer 28

Direct Bubble Effects-Bubbles forming in the tissues (autochthonous bubbles) and in the bloodstream (circulating bubbles)

indirect bubble effects- because a bubble acts like a foreign body. The body reacts as it would if there were a cinder in the eye or a splinter in the hand. The body’s defense mechanisms become alerted and try to eliminate the foreign body.

Question 29

List the max permissible recompression chamber exposure times for the following temperatures.

greater than 104
95-104
85-94
less than 84

Answer 29

greater than 104 - intolerable no treatment

95-104 - 2 hours TT 5,9

85-94 - 6 hours TT 5, 6, 6A, 1A, 9

less than 84 - Unlimited all treatments