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CLASS 22005 DIVE > CLINICAL CARE > Flashcards

CLINICAL CARE Flashcards

1
Q

(1) During a dive a diver’s blood and tissues absorb additional nitrogen/helium from the lungs when at depth.
(2) If a diver ascends too fast this excess gas will separate from solution and form bubbles. These bubbles produce mechanical and biochemical effects that lead to a condition known as decompression sickness***.

A

Decompression Sickness (DCS)

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2
Q

involves the skin, lymphatic system, muscles, and joints. It is not life threatening

A

Type I

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3
Q

itching and Cutis Marmorata. Cutis Marmorata is characterized by a marbled bright red***, purplish or even bluish pattern on the skin.

A

Skin Symptoms

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4
Q

outside of the thorax, knees, ankle, elbow and wrist. Pain is typically a dull achy pain that is unable to be pinpointed.

A

Joint Pain

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5
Q

***Joint Pain and Skin Symptoms

Pain, marbling, and swelling***

A

DCS Type I

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6
Q

Treatment of DCS Type I

A

(a) Complete a full neurological exam to rule out AGE or DCS Type II **
(b) 100% Surface Oxygen via non rebreather mask
(c) Transport to the nearest Recompression Chamber
* **NOTE: If transport by helicopter maintain an altitude less than 1000ft. **

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7
Q

a serious & possibly life threatening illness. DCS Type II symptoms are divided into three categories (Neurological, Inner Ear & Cardio Pulmonary)

A

Type II DCS

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8
Q

Neurological DCS

A

1) Numbness
2) Paresthesia’s
3) Muscle weakness
4) Mental status changes
5) Impaired urinary function

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9
Q

Inner Ear DCS

“staggers”

A

1) Tinnitus
2) Hearing Loss **
3) Vertigo **
4) Dizziness
5) Nausea *
6) Vomiting*

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10
Q

Cardiopulmonary DCS

“Chokes”

A

1) Chest pain
2) Painful inspiration
3) Irritating Cough
4) Tachypnea
5) Lung congestion
6) Complete circulatory collapse *** Biggest risk factor

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11
Q

Treatment of DCS Type II

A

(a) Complete a full neurological exam to rule out AGE (Arterial gas embolism)

  • **NOTE: Treatment for DCS TypeII and AGE are the same.
    (b) 100% Surface Oxygen via non rebreather mask
    (c) Transport to the nearest Recompression Chamber
  • **NOTE: If transport by helicopter maintain an Altitude less than 1000ft
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12
Q

***Neurological, Inner Ear, and Cardiopulmonary symptoms

A

DCS Type II

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13
Q

occurs when gas is forced through torn lung tissue into the loose mediastinal tissues in the middel of the chest surrounding the heart, trachea, and major vessels.

A

Pulmonary Over Inflation Syndrome

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14
Q

1) Mild to moderate pain under the breastbone
2) Pain that radiates to the shoulder or back.
3) Fullness around the neck and difficulty swallowing
4) Voice
5) Palpation of the skin near the trachea may result in crepitus (cracking or crunching sound)

A

Mediastinal/Subcutaneous

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15
Q

Mediastinal/Subcutaneous

A

Mediastinal emphysema

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16
Q

Treatment of Mediastinal emphysema

A

(a) Neuro to rule out AGE **
(b) Cardio/Lung exam to rule out pnuemothorax **
(c) 100% surface oxygen
(d) Shallow recompression to 5-10FSW may be warranted until symptoms resolve
* not my call. has to come from someone smarter.

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17
Q

Caused by air leaking from the tissues of the lungs into the space between the lungs and chest wall. A simple pneumothorax is a onetime escape of gas, while a tension pneumothorax is caused when air continues to escape and collapses the lung which compromises cardiac function.

A

Pneumothorax

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18
Q

(a) Sudden, sharp chest pain **
(b) Shortness of breath **
(c) Labored breathing ***
(d) Rapid heart rate
(e) Weak pulse
(f) Anxiety (impending doom)

A

Pneumothorax

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19
Q

Treatment of Pneumothorax

A

(a) Heart/lung exam
(b) 100% O2
(c) Needle-decompression or chest tube as warranted

20
Q

(1) Damage to body tissues from the mechanical effects of pressure, results when pressure differentials between body cavites
(2) During a normal ascent and decompression procedures, these gasses come out of the diver’s body at a manageable rate.

A

Barotrauma

21
Q

Types of Barotrauma

A

(1) Ear squeezes
(2) Sinus squeeze
(3) Tooth squeeze

22
Q

The Eustacian tube enables a diver to equalize pressure in ***

A

the Middle ear.

23
Q

If the diver cannot equalize the pressure in the Middle ear the diver will experience a “squeeze”. A squeeze may result in

A

Tympanic membrane rupture, tissue damage, and possible injury to the Coclea/vestibular apparatus.

24
Q

Symptoms of Ear squeeze

A

(a) Sharp pain in the ear
(b) Rupture of the tympanic membrane
(c) Vertigo
(d) Tinnitus
(e) Hearing Loss
(f) Nausea/Vomiting

25
Q

Treatment of Ear squeeze

A

(a) HEENT exam
(b) Decongestants
(c) Pain medication
* **NOTE: If a ruptured eardrum is suspected do not administer medication directly into the ear canal without consultation of a ear, nose & throat Specialist.

26
Q

(1) A diver’s air supply can be contaminated by _____ when the compressor intake is placed to close to the compressor’s engine exhaust

A

carbon monoxide

27
Q

seriously interferes with the bloods ability to carry the oxygen required for the body to function normally. The affinity of carbon monoxide for hemoglobin is 210 times that of Oxygen.

A

carbon monoxide

28
Q

Symptoms of Carbon Monoxide Poisoning

A

(1) Headache
(2) Dizziness
(3) Confusion
(4) Nausea
(5) Vomiting
(6) Tightness across the forehead

29
Q

Treatment of Carbon Monoxide Poisoning

A

(1) Getting the diver to fresh air
(2) 100% surface oxygen
(3) Transport to hyperbaric or medical treatment facility.

***Note: Hyperbaric therapy is the definitive treatment of choice and transportation to a recompression chamber should not be delayed except to stabilize the patient.

30
Q

(1) an abnormally high level of carbon DIOXIDE (not monoxide) ** in the blood and body tissues.
(2) In diving operations, hypercapnia is generally the result of a buildup of carbon dioxide in the breathing supply or an inadequate respiratory minute volume.

A

Hypercapnia

31
Q

Symptoms of Hypercapnia

A

(1) Increased breathing rate
(2) Shortness of breath
(3) Confusion or feelings of euphoria
(4) Inability to concentrate
(5) Increased sweating
(6) Drowsiness
(7) Headache
(8) Loss of consciousness
(9) Convulsions

32
Q

Treatment of Hypercapnia

A

(1) Decreasing the level of exertion to reduce CO2 production
(2) Increasing helmet and lung ventilation to wash out excess CO2
(3) Shifting to alternate breathing source of aborting the dive if defective equipment is the cause.

33
Q

Exposure to a partial pressure of oxygen above that encountered in normal daily living may be toxic to the body. The extent of the toxicity is dependent upon both the oxygen partial pressure and the exposure time

A

Central Nervous System Oxygen Toxicity

34
Q

The two areas of the body affected by Central Nervous System Oxygen Toxicity are the

A

Central Nervous System and the Pulmonary System.

35
Q

Symptoms of Central Nervous System Oxygen Toxicity

A

(1) Tunnel vision, decreased peripheral vision, and other visual symptoms
(2) Tinnitus
(3) Confusion/Euphoria
(4) Inability to concentrate
(5) Increased sweating
(6) Drowsiness
(7) Headache
(8) Loss of consciousness
(9) Convulsions

36
Q

Treatment of Central Nervous System Oxygen Toxicity

A

(1) Immediately ascend **
(2) Shift to a breathing mixture with lower oxygen percentage **
(3) In a recompression chamber, remove oxygen mask and follow emergency procedures

37
Q

sometimes called low pressure oxygen poisoning, can
occur whenever the oxygen partial pressure exceeds 0.5ata. A 12 hour exposure to a partial pressure of 1ata will produce mild symptoms and measureable decreases in lung function.

A

Pulmonary Oxygen Toxicity

38
Q

Symptoms of Pulmonary Oxygen Toxicity.

A

(1) Burning sensation during inspiration
(2) Pain during inspiration
(3) Cough
(4) Decreased pulmonary function

39
Q

Treatment of Pulmonary Oxygen Toxicity.

A

(1) If the patient cannot continue with respiratory discomfort, remove the patient from O2
(2) Consult DMO (Diving Medical Officer) to modify treatments, increasing air time of air breaks between oxygen periods.

40
Q

While conducting breath hold operations, oxygen PPO2 is higher at depth. During ascent the PPO2 decreases and increases the risk of hypoxia and unconsciousness. ***The biggest risk of shallow water black out is subsequent drowning.

A

Shallow Water Blackout

41
Q

Symptoms of Shallow Water Blackout

A

(1) Unconsciousness close to the surface or subsurface
(2) Hypoxia
(3) Subsequent drowning
(4) Cardiac/Respiratory arrest

42
Q

Treatment of Shallow Water Blackout

A

(1) In water: Ventilation only, open airway, check breathing, provide 5 rescue breaths
(2) Do not attempt compressions in the water
(3) Rule out cardiac arrest once on the boat/shore
(4) If the patient is pulseless continue CPR utilizing ABCs (Airway, Breathing, Circulation) ***
(5) Transport to the nearest emergency department
* **NOTE: Immediate CPR and application of an Automated External Defibrillator (AED) is indicated for a diver with no pulse or respirations (cardiopulmonary arrest). Access to advanced cardiac life support (ACLS) is a higher priority than recompression. If the pulseless diver regains vital signs continue, or begin, transport to the nearest critical care facility prior to recompression.

43
Q

(1) Occurs during swimming or diving operations. Often in young individuals with no predisposing conditions.
(2) Believed to be related to exertion, immersion in cold water and overhydrating

A

Swimmer Induced Pulmonary Edema (SIPE)

44
Q

Symptoms of Swimmer Induced Pulmonary Edema (SIPE)

A

(1) Dull to sharp substernal chest pain
(2) Hemoptysis (coughing up blood)
(3) Shortness of breath
(4) Frothy sputum
(5) Shortness of breath

45
Q

Treatment of Swimmer Induced Pulmonary Edema (SIPE)

A

(1) Remove patient from the wet/cold environment
(2) Supplemental oxygen
(3) Complete heart/lung exam
(4) EKG
(5) X-ray within 2 hours
(6) For critical patients, follow BLS/ACLS algorithms and transport to Emergency Department

CLASS 22005 DIVE (1 decks)

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