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U.S. Navy Diver Chamber Supervisor > Chamber Supervisor > Flashcards

Chamber Supervisor Flashcards

1
Q

What is the Equation for electing Sur-D during 30 or 20 foot stops on O2?
(Ref. 9-19)

A

( 1.1 x O2 time remaining) / 30 = chamber O2 periods required rounded up.

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2
Q

What is the equation for electing Sur-D during decompression on air?
(Ref. 9-19)

A

(Total air time/total O2 time at 30’) = Trading Ratio

(Remaining air time at 30’/trading ratio)= Equivalent O2 time at 30’

(Total O2 time at 20’ + Equivalent O2 remaining at 30’)= total O2 time remaining

(Total O2 time/1.1)=Total

(Total/:30)= O2 time in chamber rounded up to next whole half period.

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3
Q

What is the Equation for converting to air with permanent loss of O2 during Sur-D?
(Ref. 9-41)

A

(30’ air time + 20’ air time)=Number

(30’ O2 time + 20’ O2 time)= number

(Total air/Total O2)= Super Ratio

(Total O2 time remaining in chamber x Super Ratio)= Total time on air remaining, rounded up

Total time remaining:
10% at 40’
20% at 30’
70% at 20’

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4
Q

What do you do for a Surface Interval Greater than :5 but less than :7 for a Sur-D dive?
(Ref. 9-39)

A

Add :15 penalty to the 50’ stop.

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5
Q

What do you do for a surface interval greater than :7 during a Sur-D dive?
(Ref. 9-40)

A

Recompress to 60’
TT5 for 2 or fewer chamber Periods
TT6 for More than 2 Chamber Periods

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6
Q

Explain the “Safe way out Procedure”

Ref. 9-40

A

In the event a diver is unable to clear during a Sur-D while in the chamber the supervisor may elect to start O2 time at the deepest attainable depth.
If the divers surface from 30’ the supervisor should try and creep the divers to at least 30’
If the divers surface from 20’ the supervisor should try and creep divers to at least 20’
Double your chamber 02 periods.
O2 time starts when divers go on O2.

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7
Q

What is the procedure for Type 1 DCS during a surface interval?
(Ref. 9-40)

A
  • Identify the diver and location of symptoms.
  • Once the diver has been stripped out of gear conduct a rapid sweep assessment of the affected diver.
  • Send Inside Tender in chamber with divers.
  • Conduct a full Neurological Exam at 50’ during the first :15 period.
  • If the the Type 1 symptoms resolve in the first :15 and the Surface Interval was :5 or less increase the 50’ stop time from :15 to :30 then continue with the scheduled decompression for the dive.
  • If the type 1 symptoms do not resolve in the first :15 or the Surface Interval was greater than :5 minutes press the divers to 60’ on oxygen.
  • Treat the divers on a TT5 if the original decompression schedule called for 2 or fewer chamber periods.
  • Treat the divers on a TT6 if the original decompression schedule called for MORE THAN 2 chamber periods.
  • Treatment table time starts when the divers reach 60’ in the chamber.
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8
Q

Describe Table 9-2 Management of extended surface interval and type 1 DCS during surface interval.
(Ref. 9-41)

A
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9
Q

Explain the loss of O2 during a Sur-D dive.

Ref. 9-41

A

•If the loss is temporary return the divers to breathing O2 as soon as possible.
•If the loss is permanent use the calculation for loss of O2 to determine how much decompression time you owe the divers.
•if you have to do the times at your 30’ and 20’ stops you will do:
30% at 30’
70% at 20’

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10
Q

Explain the procedure for CNS-O2 Toxicity in the chamber during a Sur-D dive.
(Ref. 9-42)

A

•First hit non-convulsive.

  • Remove mask
  • After all symptoms have completely subsided start a :15 minute penalty of breathing chamber air.
  • following the conclusion of the :15 resume oxygen breathing at the point of interruption.

•2nd hit or convulsion

  • Remove mask
  • Once symptoms have completely subsided and the patient is fully relaxed and breathing normally begin ascending 10’ at 1’ per minute.

•If another symptom occurs after ascending 10’ complete the Sur-D on air.
- Using the formula for loss of O2 calculate how much time on air is required to complete the decompression.
10% at 40’
20% at 30’
70% at 20’

Always round up.

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11
Q

Explain table 9-3, Management of Asymptomatic Omitted Decompression.

A
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12
Q

Explain the chamber procedures following in water CNS O2 Convulsions.
(Ref. 9-38)

A

Multiply the remaining O2 time at the stops by 1.1, then dividing the total by :30. Round up to the nearest half period. :15 at 50’ is the minimum.

TR x 1.1= Total

Total/:30= Periods in chamber

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13
Q

Explain chamber procedures following NON CONVULSIVE CNS-O2 tox.
(Ref. 9-37)

A

Initiate Sur-D.
Shift to air during travel to surface.
Compute the number of chamber oxygen periods by multiplying the remaining oxygen time at the stops by 1.1
Divide the total by 30 minutes then round up to the next highest half.period.
:15 at 50’ is a minimum

RT x 1.1= Total
Total/:30= chamber 02 periods

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14
Q

Explain the procedures following in water DCS during in water Decompression.
(Ref. 9-45)

A
  1. Dispatch Standby diver to assist. Continue to decompress other divers according to original schedule.
  2. If diver is at 30 or 20 foot stop on air, switch diver to 100% O2 if available.
  3. Have the diver descend 10 fsw. If significant relief is not obtained descend additional 10 fsw not to exceed 40’ if diver is on O2.
  4. Remain at treatment depth for at least :30
  5. If diver is on air resume decompression by multiplying air and O2 times by 1.5.
  6. If recompression went deeper than original first stop, insert intervening stops in 10’ increments.
  7. If the diver is undergoing treatment on O2 at 40’ return to surface by multiplying 30 and 20’ stops by 1.5
    If original schedule did not call for a 30’ stop insert a 30’ stop equal to the stop time at 20’
  8. If the diver is undergoing treatment at 30’, return to surface by multiplying the 20’ stop by 1.5 for new 20’ stop.
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15
Q

Explain the procedures for in water DCS treatment with level 1 chamber.
(Ref. 9-46)

A

If chamber is immediately available treat diver in water for :30 then surface the diver for further treatment in chamber.

  • The surface interval MUST be :5 or less.
  • The diver should be considered to have Type 2 DCS even if symptoms are type 1.
  • After completing treatment monitor on surface for 6 hours
  • if symptoms reoccurr treat as reoccurrence of type 2 symptoms.
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16
Q 
What are the manning requirements for the chamber? 
•Emergency 
•Minimum
•Preferred 
(Ref. 17-2)
A 
Ideal: 7
-Diving Officer
-Master Diver
-Chamber Supervisor 
-UMO
-Inside Tender
-Log Keeper
Outside Tender

Minimum: 3

  • Chamber Supervisor
  • Inside Tender
  • outside tender
  • Emergency: 2
  • Chamber Supervisor
  • Inside Tender
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17
Q

What are the responsibilities of the Chamber Supervisor?

(Ref. 17-3

A
  1. Communicating with personnel inside the chamber.
  2. Adhering to minimum manning level for conducting recompression treatment.
  3. Ensuring every member of chamber team is familiar with all treatment procedures.
  4. Ensuring an UMO is contacted at the earlier opportunity during treatment and before release of patient from treatment.
  5. Ensuring details related to assessment and treatment of patient are thoroughly documented in chamber log in accordance with chapter 5-5 and command dive bill.
  6. Tracking bottom time and decompression profiles or personnel locking in and out of chamber.
  7. Ensuring decompression profiles of persons locking in and out of chamber are logged in chamber log.
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18
Q

What are the symptoms of AGE?

Ref. 17-7

A
  • Extreme Fatigue
  • Difficulty in thinking
  • Vertigo
  • Nausea or vomiting
  • Hearing abnormalities
  • Bloody sputum
  • Loss of control of bodily functions
  • Tremors
  • Loss of coordination
  • Numbness
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19
Q

What considerations should be taken for someone expected to have and AGE?

A
  • Consider that more than one POIS may have taken place.
  • Listen to lungs
  • examine patient for signs and symptoms of pneumothorax, mediastinal emphysema, subcutaneous emphysema.
  • conduct full neuro at earliest opportunity.
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20
Q

What is the treatment of a pulseless or breathless diver?

Ref. 17-7

A
  • Begin CPR
  • Get AED and apply as needed
  • Advance Cardiac Life Support is higher priority than recompression.
  • All efforts must be made to transport patient to highest level of medical care available.
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21
Q

What are the symptoms of type 1 DCS?

REF 17-9

A

P: Joint pain (musculoskeletal or pain only)
M: Marbling of the skin
S: Swelling of the lymph nodes.

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22
Q

What are the symptoms of type 2 DCS?

Ref 17-11

A

C: Cardiopulmonary (chokes)
N: Neurological
S: Inner Ear (staggers)

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22
Q

What are the symptoms of type 2 DCS?

Ref 17-11

A

C: Cardiopulmonary (chokes)
N: Neurological
S: Inner Ear (staggers)

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23
Q

Always and Nevers

Ref 17-10 table 17-2

A
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24
Q

What are the treatments of Type 1 DCS?

Ref 17-11

A

With a full neurological exam on surface and complete relief and a full neuro within the first ten minutes at 60’ a treatment table 5 may be used.
If a neuro was not able to be completed on the surface or the symptoms are not completely relieved within the first ten minutes of treatment at 60’ a treatment table 6 shall be used.
If the patient has Marbling of the skin it shall be treated as type 2 DCS.

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25
Q

What are the Inner Ear Symptoms or Staggers?

Ref 17-12

A

Tinnitus, hearing loss, vertigo, dizziness, nausea and vomiting.

Not Inner Ear Barotrauma.

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26
Q

What are the Cardiopulmonary or Chokes Symptoms?

Ref 17-12

A

Chest pain aggravated by breathing in, or as irritating cough.
Increased breathing rate. Increased lung congestion may progress to complete circulatory collapse. Loss of consciousness, death.
Careful examination for pneumothorax should be used.

27
Q

What is the treatment for type 2 DCS?

Ref 17-12

A

Compression to 60’ and administration of 100% O2. The first :20 is an observation period. If the symptoms are improved in the first oxygen breathing period follow a treatment table 6.
For severe symptoms that are unchanged or worsening within the first :20 period assess the patient and decompress to the depth of relief not to exceed 165’ follow a treatment table 6A.
To limit recurrence severe type 2 symptoms warrant full extensions at 60’ even if symptoms resolve during the first oxygen breathing period.

28
Q

What are the procedures for symptomatic omitted decompression?

(Ref 17-13)

A

Recompression immediately to 60’. Conduct a rapid assessment at 60’ and proceed accordingly. If the diver surfaced from 50’ or shallower compress to 60’ and treat on a treatment table 6. If the diver surfaced from a depth deeper than 50’ compress to 60’ or the depth where symptoms are significantly improved not to exceed 165’. For uncontrolled ascent deeper than 165 use treatment table 8 not to exceed 225’.
Consultation with UMO as soon as possible should be made.

29
Q

What is the treatment for altitude DCS?

Ref 17-13

A

If symptoms resolve before reaching 1 ata have patient breath 100% oxygen for 2 hours and observe for 24 hours.

If symptoms are still present when patient reaches 1 ata treat on a treatment table 5. Even if symptoms resolve in transit to chamber the patient must complete a treatment.

30
Q

What are 3 primary objectives of recompression treatment?

Ref 17-14

A

1- Compression gas bubbles to restart blood flow.
2- Allow sufficient time for bubble reabsorption.
3- Increase blood oxygen content to help with injured tissues.

31
Q

What are 5 facets of recompression treatment?

Ref 17-14

A

1- Treat promptly and adequately.

2- The effectiveness of treatment decreases as the length of time between the onset of symptoms and treatment increases.

3- Do not ignore seemingly minor symptoms. They can quickly become major symptoms.

  1. Follow the selected treatment table unless changes are recommended by a UMO.

5- If multiple symptoms occur, treat the most severe.

32
Q

What are the procedures for treatment when oxygen is not available?

A

1- Use of a treatment table 1A may be used for pain related symptoms as long as symptoms are resolved at a depth less than 66’

2- Use a treatment table 2A if pain symptoms are resolved deeper than 66’

3- For serious symptoms use a treatment table 3.

4- If symptoms are relieved within the first 30 minutes at 165’ stay on a treatment table 3. If symptoms are not resolved in less than 30 minutes at 165’ use a treatment table 4.

33
Q

What are the uses for a treatment table 5?

Ref 17-17

A
  • Type 1 DCS not including Marbling
  • Asymptomatic omitted decompression
  • Treatment of resolved symptoms following in water recompression
  • Follow up treatment for residual symptoms
  • Carbon Monoxide Poisoning
  • Gas gangrene
34
Q

What are the uses for a treatment table 6?

Ref 17-18

A
  • Arterial Gas Embolism
  • Type 2 DCS
  • Type 1 DCS where symptoms are not resolved in 10 minutes
  • Marbling of the skin
  • Severe CO poisoning, cyanide poisoning, smoke inhalation
  • Symptomatic uncontrolled ascent
  • Asymptomatic omitted decompression
  • Recurrence of symptoms shallower than 60’
35
Q

What form is used to treat non military or civilians?

Ref Command Dive Policy

A

Request for administration of anesthesia

Optional Form 522

36
Q

What is a treatment table 6A used for?

A

Used to treat AGE or severe DCS when symptoms remain unchanged or worsen at 60’.

37
Q

What do you do for recurrence of symptoms shallower than 60’?
(Ref 17-42)

A

Place diver on oxygen compress the 60’ complete 3 oxygen breathing periods. Decompress on treatment table 6.

38
Q

What do you do for recurrence of symptoms deeper than 60’?

Ref 17-42

A

Compress diver the 165’ off oxygen. Remain at depth for 30 minutes on air or Treatment gas.
If more time is needed use treatment table 4 or 7 with concurrence from UMO.
If more time is not needed enter treatment table 6A.

39
Q

What is the use of a treatment table 4?

Ref 17-18

A

Treatment Table 4 is used when it is determined that the patient would receive additional benefit at depth of significant relief not to exceed 165’.

40
Q

When can a patient eat and sleep in the chamber?

Ref 17-20

A

Eating- the patient may eat at anytime. Fluid intake should be maintained at least 75-100cc an hour.

Sleeping- The patient may sleep when they are not breathing oxygen when deeper than 30’
The patient may sleep at anytime when 30’ and shallower. Monitor vitals while sleeping.

41
Q

Who can recommend a treatment table 9?

(Ref 17-21

A

Treatment table 9 is used for Hyperbaric Oxygen Therapy. The treatment can only be recommended by a UMO that is aware of the patient’s condition.

42
Q

What are 5 non-diving disorders that can be treated in a chamber?

(Ref 17-21)

A
  1. Cyanide poisoning
  2. CO Poisoning
  3. Gas gangrene
  4. Smoke inhalation
  5. Necrotizing soft tissue infections
43
Q

What are the minimum and maximum levels of oxygen for the chamber?

(Ref 17-23)

A

Oxygen must be kept at 19-25%

44
Q

What are the maximum levels of CO2 allowable in the chamber?

(Ref 17-23)

A

Depths.

30’ = .78%

60’ = .53%

165’ = .25%

45
Q

What are the maximum levels of CO2 allowable in the chamber?

(Ref 17-23)

A

Depths.

30’ = .78%

60’ = .53%

165’ = .25%

46
Q

What is the acceptable hydration amount by mouth and IV?

Ref 17-25

A

If possible to have the patient consume fluid by mouth 1 or 2 liters of water or juice over the course of a treatment table 5 or 6 is usually sufficient.

If the patient cannot consume fluid by mouth they should receive 75-100cc per hour via IV.

Use lactated ringers, or normal saline.

Avoid using dextrose if brain or spinal cord injury is present.

47
Q

What are the tending frequencies?

Ref 17-25

A

Allow a surface interval of at least 18 hours between consecutive treatments on TT1A, TT2A, TT3, TT5, TT6, and TT6A

Allow a surface interval of at least 48 hours between consecutive treatments on TT4, TT7, and TT8

48
Q

What is the procedure for CNS Oxygen Toxicity on TT5, TT6, and TT6A?

A

First hit:
• Remove Mask
• Wait for symptoms to subside
• Wait 15 minutes after symptoms have subsided
• Resume oxygen breathing at the point of interruption.

Second hit or Convulsions:
• Remove Mask
• Wait for symptoms to subside or patient is relaxed and breathing normally
• decompress 10’ @ rate of 1ft per minute.
• Resume at point of interruption

If another oxygen symptoms occurs after ascending 10’ contact UMO for appropriate modifications to treatment schedule.

49
Q

What is the procedure for loss of oxygen during a treatment?

(Ref 17-27)

A

15 minutes or less = resume at point of interruption

More than 15 minutes but less than 2 hours = resume at point of interruption and use maximum extensions on treatment table.

More than 2 hours = switch to a comparable air table.

50
Q

What is the procedure for switching to an air treatment table?

(Ref 17-28)

A

If oxygen breathing cannot be restored in two hours switch to a comparable air table at the current depth of 60’ or shallower.

If symptoms worsen and an increase in depth is needed beyond 60’ use a treatment table 4.

51
Q

What is the procedure for treatment at altitude?

Ref 17-28

A

Before starting recompression therapy the chamber depth gauges must be zeroed to adjust for the altitude.
For the patient no correction is needed.
For inside tenders it is considered a dive at altitude and the appropriate correction for the altitude should be used.
Tenders remaining in chamber Ford the full treatment table must breath oxygen during the terminal portion of the treatment to satisfy their decompression requirement

52
Q

What are the post treatment observation periods?

Ref 17-28

A

Treatment Table 5 = remain around recompression chamber for 2 hours

Treatment Table 6 = patients that have complete relief should remain around recompression chamber for 6 hours

Treatment Tables 6, 6A, 4, 7, 8, or 9 are likely to require a period of hospitalization. A UMO will determine post treatment time. No patient shall be released until authorized from a UMO.

53
Q

For residual symptoms, how many days may a patient receive consecutive treatments?

(Ref 17-30)

A

Treatments should not be administered on a daily basis for more than 5 days without a break of at least one day.

54
Q

What are the procedures for death during treatment?

Ref 17-31

A

If death occurs following initial recompression to 60, 165, or 225 on treatment tables 6, 6A, 4, or 8 decompress tenders on Air/oxygen schedule.
If death occurs on a treatment table 4, 8 or starting a 7 decompress on scheduled decompress for treatment table. Or call NEDU for costumized decompress schedule.

55
Q

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

(Ref 17-32)

A

If deeper than 60’ go immediately to 60’.

Once the chamber is at 60’ feet or shallower put all occupants on continuous 100% oxygen.

Select the Air/oxygen schedule corresponding with the max depth attainted and total time elapsed.

If at 60’ breath oxygen for sum of all stops 60’ and deeper then continue decompression breathing oxygen continuously.

If shallower than 60 breath oxygen for period of time equal to the sum of all decompress stops deeper than current depth. Continue decompression on appropriate decompression schedule for table/schedule.

When no time is available bring all occupants to surface at a rate of 10’ per minute. Keep all occupants on 100% oxygen during the whole evacuation.

Immediately evacuate to near recompression treatment facility. If no symptoms occured after evacuation follow a treatment table 6.

56
Q

What are the three support levels of chambers?

A
  1. A US Navy certified recompression chamber close enough to the dive site to support surface decompression with a surface interval of 5 minutes.
    - Notes 1,2,5
  2. A US Navy recompression chamber accessible within one hour of casualty.
    - Notes 2, 5
  3. A US Navy certified recompression chamber accessible within six hours of casualty.
    - Notes 3,4,5
57
Q

What is Note 1 in relation to chamber support levels?

Ref 18-1

A

Note 1: the commanding officer may authorize an extension of the surface interval to a maximum of 7 minutes.

58
Q

What is Note 2 in relation to support level for chambers?

Ref 18-1

A

Note 2: A non-US chamber may be used if authorized in writing by the first flag officer in the chain of command, and must include a NAVSEA 00C hazard analysis.

59
Q

What is Note 3 in relation to chamber support levels?

Ref 18-1

A

A non US chamber may be used if it is evaluated utilizing NAVSEA non Navy recompression chamber check sheet, and authorized in writing by the commanding officer.

60
Q

What is Note 4 in relation to chamber support levels?

Ref 18-1

A

During extreme circumstances when a chamber cannot be reached within 6 hours the commanding officer (or designated individual) can give authorization to use the nearest recompression facility.

61
Q

What is Note 5 in relation to chamber support levels?

Ref 18-1

A

Utilizing a non US Navy chamber will likely require treatment to be completed in accordance with host nation facility recompression treatment protocols.

62
Q

What category of chamber is at UCT one?

Ref 18-16

A

Category D

  • BIBS overboard dump
  • CO2 scrubber
  • Air BIBS
  • O2 and CO2 monitor

Inner lock once outer lock twice to 165 fsw (sufficient air to power scrubber)

Inner lock and outer lock once to 165fsw

63
Q

What is treated with shallow water decompression, what is the depth and time?

(Ref 3-36)

A

Shallow water recompression is used to treat severe symptoms of Subcutaneous and mediastinal emphysema. Breath 100% oxygen at 5-10 feet for 1 hour. Shallow water recompression should only be carried out upon recommendation of a UMO.

64
Q

What are the EPs for the chamber?

A
  1. Rapid Increase in pressure
  2. Decrease in pressure
  3. Contaminated atmosphere
  4. Fire in the chamber
  5. Loss of oxygen
  6. Loss of primary Air TRC
  7. Loss of primary Air TL
65
Q

What are the sub classification for UMO who can modify treatments?

A

16U0

16U1

U.S. Navy Diver Chamber Supervisor (1 decks)

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