Chamber Treatments Flashcards
What do you do if there is no change in pain after the second O2 period at 60 feet?
Consult UMO, If no UMO treat on Table 6
When do you continue at 60 feet on a table 6?
If symptoms are IMPROVED within the first O2 period
When do you go deeper than 60?
If severe symptoms are UNCHANGED or WORSEN within first 20 minutes
What are considered sever symptoms?
Memory loss, paralysis, major weakness, altered conciousness
When are max extensions at 60fsw warranted?
For severe Type II symptoms even if resolved within first O2 period
Is TT5 an appropriate treatment table for SYMPTOMATIC Omitted D?
NO
What are the treatments for Symptomatic Omitted D?
50 FSW or shallower - treat at 60 FSW on TT6
Deeper than 50 FSW - treat at 60 FSW or deeper not to exceed 165 FSW and treat on TT6a
Treatment for Aviation Deco sickness with pain only symptoms?
Pain was resolved before reaching 1 ATA - 2 hours surface O2 with 24 hours of observation following
OTHERWISE treat on appropriate treatment table
What do you do if symptoms return when treating on a table 6?
Treat as recurrence
What authorization is need for HBO therapy?
BUMED Code M95
O2 less than what percentage requires action and what are those actions?
<19% - ventilate or add O2 thru bibs
O2 greater than what percentage requires action and what are those actions?
> 25% - ventilate, secure O2 from bibs, check lines all the way back to manifold, secure O2 valve on chamber, secure O2 bottles
What should chamber CO2 levels not exceed? And what actions are taken to fix this?
1.5% of SEV
Ventilate, use CO2 scrubber
What temperature should you try to stay below for treatments>
85F
Above what temperature can you not run a treatment table 6?
> 94 degrees
How can you cool down a chamber first?
Ventilate
What are the O2 breathing limitations on tenders?
- One occupant must breathe air when deeper than 45 FSW
What gas mixture is used for treatment depths deeper than 60?
50/50 nitrox or heliox
Procedure for O2 hit no convulsion?
- off O2
- wait for symptoms to subside
- then wait an additional 15 minutes
- resume O2 from point of interruption
Procedure for 2nd O2 hit or convulsion?
- off O2
- wait for ALL symptoms to subside (FULLY RELAXED AND BREATHING NORMAL)
- ascend 10 FSW at 1’/min
- resume O2 from point of interruption
What are some options for treatment of Pulm O2 tox?
- Change O2 breathing to 20 min and 10 min air breaks
- Nitrox 50/50 considerations
What is 50/50 gas mixture O2 percentage at 60 FSW?
roughly 140%
What are the O2 loss time lines?
<15 minutes
15 minutes to 2 hours
> 2 hours
What do you do for O2 loss less than 15 minutes
Stay and play from point of interruption
What do you do for O2 loss between 15 minutes and 2 hours?
Stay and play with max number of O2 extensions
What do you do for O2 loss >2 hours?
- consider air table but also consider 50/50
Tender considerations following treatment on 5,6,6A,1A,2A,3
Surface interval of 18 hours before No-D
Surface interval of 24 hours before D
Remain in vicinity for 1 hour
Patient considerations following treatment?
2 hours for TT5
6 hours for TT6
Within 30 minutes if with someone experienced and per UMO rec
Hospitalization and further studies as required to return to diving as outlined in MANMED Ch.15-102
What are the tender O2 breathing requirements?
TT6 1 ext @ 60 or 30 - 30 minutes
TT6 >1 ext - 60 minutes
TT6A 1 ext @ 60 or 30 - 60 minutes
TT6A >1 ext - 90 minutes
Previous hyperbaric exposure within 18 hours - add 60 minutes on top
Treatment for lower extremity paralysis and DCS
Enoxaparin 30mg Subq every 12 hours
What are the fluid concerns for AGE?
Cerebral edema can increase damage to CNS therefore do not fluid overload patient
When must the patient be kept awake?
Deeper than 30 breathing O2
Initial treatment for recurrence of symptoms during treatment shallower than 60?
Diver on O2 and compress to 60
Complete 3 20 min O2 periods at 60
What is the descent rate for TT5, 6, 6A?
20ft/min
30 sec per 10 feet
What is the ascent rate for TT5 and 6?
1 ft/min
What is the ascent rate for TT6A?
3 ft/min from 165 to 60
1 ft/min from 60 to surface
What if a diver ascends faster than 30 fsw/min but is asymptomatic and has missed no decompression stops?
Monitor for 1 hour
How should in water decompression sickness be treated if a level 1 chamber is available?
Treat as type 2 DCS in the chamber
What is the surface interval time for surface decompression?
When diver leaves 40 foot stop and reaches 50 foot stop in the chamber
What is the ascent rate from 40fsw to the surface when conducting surface deco?
40 ft/min
Last page of stuying?
9-15 Surface decompression
How is %CO2 determined for 1.5 SEV?
1.5 / ATA
I.E. 1.5 / 2.8 (60FSW) = 53%
1.5 / 1.9 (30FSW) = 79%
Where is the first period of Surface D spent and for how long?
50 FSW for 15 minutes
How long is a period in surface D?
30 min
How fast does the diver surface following O2 periods?
30 f/min
How fast do you travel from 50 FSW to 40FSW in first Surd O2 period?
After 15 min, travel at 30 f/min to 40 FSW
How many periods are spent at 40 FSW? Surd
2-4
How many periods are spent at 30 FSW? Surd
> 4
How do you travel to 30 FSW if more than 4 periods? Surd
On air break at 30 f/min
How long are the air breaks on Sur D?
5 minutes
For SUR D, how is a diver surfaced following last O2 period?
Off O2
Ascend 30 f/min to surface
SURD D surface interval (40fsw to 50 Feet in chamber) is greater than 5 minutes but less than 7 minutes procedure?
Add 15 minutes at 50 fsw
After 30 minutes on O2 at 50FSW, OFF O2, travel to 40 FSW at 30 f/min on air
On air for 5 minutes
Back on O2
(Basically add another half period)
Sur D surface interval is greater than 7 minutes procedure?
Compress to 60
Treat on TT5 for 2 or fewer O2 periods required
Treat on TT6 for >2 O2 periods required
What happens if the diver can’t make it down to 50 FSW on SUR D and SUR D was initiated deeper than 20 fsw in water?
Attempt to gradually compress diver to 30 Feet in the chamber
Double all O2 periods
Conduct 15 minute air breaks every 60 minutes of O2
Surface diver at 30 feet per min following all O2 periods
What do you do for If symptoms of Type I decompression sickness occur during travel from 40 fsw to the surface during surface decompression or during the surface undress phase?
compress the diver to 50 fsw
Delay neurological exam until the diver reaches the 50-fsw stop and is on oxygen
If Type I symptoms resolve during the 15 minute 50-fsw stop, the surface interval was 5 minutes or less, and no neurological signs are found, increase the 50 fsw oxygen time from 15 to 30 minutes
then continue normal decompression
What If Type I symptoms do not resolve during the 15 minute 50-fsw stop OR symptoms resolve but the surface interval was greater than 5 minutes?
compress the diver to 60 fsw on oxygen.
Treat the diver on Treatment Table 5 if the original schedule
required 2 or fewer oxygen periods in the chamber.
Treat the diver on Treatment Table 6 if the original schedule required 2.5 or more oxygen periods in the chamber.
DCS II Symptoms during SI of SURD?
Compress to 60
Treat on TT6
Loss of O2 in the chamber during SURD is temporary?
- Breathe chamber air
- Any time spent on air is dead time and return diver to O2 breathing when O2 is fixed
Loss of O2 in the chamber during SUR D is permanent?
- Complete dceompression on 50/50 OR on air
- If on 50/50 multiply remaining O2 time by 2
- Air breaks are not required
Loss of O2 and no 50/50 for SUR D?
- First calculate all remaining O2 time required for the SUR D
- Then calculate total air decompression time required if the in-water decompression was conducted
- Then calculate the total O2 decompression time required if the in-water decompression was conducted
- Divide the total air time by the total O2 time of in-water deco (This is your ratio of air to O2 stop time)
- The remaining required total time in the chamber on air is your ratio multiplied by your initial O2 chamber time remaining.
(9-12.8) - Take this total time and multiply it by .1 at 40 FSW, .2 at 30 FSW, and .7 at 20 FSW.
Uncontrolled ascent with no missed decompression, asymptomatic. What do you do?
Observe on surface for one hour
Chamber is not leaving surface, what do you check?
- If no noise - check line-up
- If noise - check soft seal and check if exhaust is open
Chamber is ascending on it’s own, what do you check?
- Secure both exhaust (large and fine)
- Add to maintain
Chamber is descending on it’s own, what do you check?
** OFF O2 **
* OK in the chamber?
* Secure primary and secondary
* EXHAUST
* Secure air bibs and O2 bibs
* Check scrubber
of valves to switch to secondary?
Close primary
Open secondary
What’s the difference between TT1a and TT2a?
66 feet
<66 feet and PAIN ONLY - 1A
>66 feet and PAIN Only - 2A
Fire?
OFF O2
All on air bibs
Fight the fire withe everything you got
Hurricane once the fire is out
Loss of O2 >2hours
- Air table at current depth
- Ask UMO to switch to 50/50
When does tender breathe on tt9?
Last 15 minutes and to surface
On second period of O2 with 15 minutes into it, patient hears loud noises what do you do?
- ASk IT if he hears it
- Off O2
- treat ask O2 hit
Treatment for CO Poisoning?
** Dive manual says severe CO poisoning is treated on TT6
What depth do you go to if knowingly you have no O2 for DCS 2 pain?
165 treat on 3A
When is treatment table 4 used when using air table?
No relief within first 30 min of tt3
What depth do you go to if you knowingly have no o2 and you’re treating for pain only DCS?
65 initially
Pain reliever <66 = TT1 so go to 100
Pain relieves deeper than 66 = TT2 so go to 165
You switch to an air table because you have o2 loss greater than 2 hours and symptoms are not relieved until deeper than 60, what do you do?
TT4
