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CLASS 22010 DIVE > CLINICAL CARE OF DIVING INJURIES > Flashcards

CLINICAL CARE OF DIVING INJURIES Flashcards

1
Q

During a dive, a diver’s blood and tissues absorb additional nitrogen/helium from the lungs when at depth; if they ascend too fast this excess gas will separate from solution and form bubbles; these bubbles produce mechanical and biochemical effects that lead to what condition?

A

Decompression Sickness

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2
Q

What type of DCS involves the skin, lymphatic system, muscles, and joints?

Not life threatening

A

Type 1 DCS

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3
Q

In what type of DCS will you see the following?

  1. Joint Pain: outside of the thorax, knees, ankles, elbows, wrists. Pain is typically a dull achy pain that is unable to be pinpointed
  2. Skin symptoms: itching and cutis marmorata; cutis marmorata is characterized by a marbled bright red, purplish or even bluish pattern on the skin
A

Type 1 DCS

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4
Q

What is the treatment for DCS type 1?

A
  1. Complete a full neuro exam to rule out AGE or DCS Type 2
  2. 100% surface oxygen via non rebreather mask
  3. Transport to nearest Recompression Chamber

**if transport by helo maintain altitude less than 1000ft

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5
Q

What type of DCS is a serious and possibly life threatening illness, the symptoms of this are divided into three categories (Neuro, inner ear, and cardio pulmonary)?

A

Type 2 DCS

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6
Q

What are some of the neuro symptoms for DCS type 2?

A
  1. Numbness
  2. Paresthesia’s
  3. Muscle weakness
  4. Mental status changes
  5. Impaired urinary function
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7
Q

What are some of the inner ear symptoms of DCS type 2?

A
  1. Tinnitus
  2. Hearing Loss
  3. Vertigo
  4. Dizziness
  5. Nausea
  6. Vomiting
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8
Q

What are some of the cardiopulmonary symptoms of DCS type 2?

A
  1. Chest pain
  2. Painful inspiration
  3. Irritating cough
  4. Tachypnea
  5. Lung congestion
  6. Complete circulatory collapse
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9
Q

What is the treatment of DCS type 2?

A
  1. Complete neuro exam to rule out AGE (Arterial gas embolism)
    • *treatment for DCS type 2 and AGE are the same**
  2. 100% Surface Oxygen via non rebreather mask
  3. Transport to the nearest Recompression Chamber
    • *if transport by a helo maintain altitude less than 1000ft
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10
Q

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

A

Pulmonary Over Inflation Syndrome (POIS)

-Mediastinal emphysema

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11
Q

What are some symptoms of Mediastinal Emphysema?

A
  1. Mild to moderate pain under the breast bone
  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)
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12
Q

What is the treatment for mediastinal emphysema?

A
  1. Neuro to rule out AGE
  2. Cardio/Lung exam to rule out pneumothorax
  3. 100% surface oxygen
  4. Shallow recompression to 5-10 FSW may be warranted until symptoms resolve
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13
Q

What is caused by air leaking from the tissues of the lungs into the space between the lungs and chest wall?

A

Pneumothorax

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14
Q

True or False

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

True

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15
Q

What are these symptoms associated with?

  1. Sudden, sharp chest pain
  2. Shortness of breath
  3. Labored breathing
  4. Rapid heart rate
  5. Weak pulse
  6. Anxiety (impending doom)
A

Pneumothorax

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16
Q

What is the treatment for a pneumothorax?

A
  1. Heart/Lung exam
  2. 100% O2
  3. Needle Decompression or chest tube as warranted
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17
Q

What is damage to the body tissues from the mechanical effects of pressure, results when pressure differentials between the body cavites; during a normal ascent and decompression procedures, these gasses come out of the diver’s body at a manageable rate?

A

Barotrauma

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18
Q

What are the types of barotrauma?

A
  1. Ear squeezes
  2. Sinus squeezes
  3. Tooth squeezes
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19
Q

What enables a diver to equalize pressure in the middle ear?

A

The Eustachian tube

20
Q

If a diver cannot equalize the pressure in the Middle ear they will experience a “squeeze” which may result in things like what?

A
  1. TM rupture
  2. Tissue damage
  3. Possible injury to the Coclea/vestibular apparatus
21
Q

These are symptoms associated with what?

  1. Sharp pain in the ear
  2. Rupture of the TM
  3. Vertigo
  4. Tinnitus
  5. Hearing Loss
    6, Nausea/vomiting
A

Barotrauma - Ear Squeeze

22
Q

What is the treatment for Barotrauma - ear squeeze?

A
  1. HEENT exam
  2. Decongestants
  3. Pain medication
23
Q

What gas can seriously interfere with the bloods ability to carry the oxygen required for the body to function normally; the affinity for this for hemoglobin is 210 that of oxygen?

A

Carbon monoxide

24
Q

What are the symptoms associated with Carbon Monoxide Poisoning?

A
  1. Headache
  2. Dizziness
  3. Confusion
  4. Nausea
  5. Vomiting
  6. Tightening across the forehead
25
Q

What is the treatment for Carbon Monoxide Poisoning?

A
  1. Get diver to fresh air
  2. 100% surface oxygen
  3. Transport to hyperbaric or MTF
26
Q

What is the definitive treatment of choice for carbon monoxide poisoning?

A

Hyperbaric therapy

-transportation to recompression chamber should not be delayed except to stabilize the patient

27
Q

What is known as an abnormally high level of carbon dioxide in the blood and body tissues?

A

Hypercapnia

28
Q

In diving operations, what is generally the result of a buildup of carbon dioxide in the breathing supply or an inadequate respiratory minute volume?

A

Hypercapnia

29
Q

These are some symptoms associated with what?

  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
A

Hypercapnia

30
Q

What is the treatment of Hypercapnia?

A
  1. Decreasing the level of exertion to reduce CO2
  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
31
Q

Exposure to a partial pressure of oxygen above that encountered in normal daily living may be toxic to the body and is known as what?

A

Central Nervous System Oxygen Toxicity

-Extent of the toxicity is dependent upon both the oxygen partial pressure and the exposure time.

32
Q

What are the two areas of the body that are affected by Central Nervous System Oxygen Toxicity?

A
  1. Central Nervous System

2. Pulmonary system

33
Q

The following symptoms may be associated with what toxicity?

  1. Tunnel vision, decreased peripheral vision, 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
A

CNS Oxygen Toxicity

34
Q

What is the treatment of CNS Oxygen Toxicity?

A
  1. Immediately ascend
  2. Shift to a breathing mixture with lower O2 percentage
  3. In a recompression chamber, remove oxygen mask and follow emergency procedures
35
Q

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

A

Pulmonary Oxygen Toxicity

36
Q

These are symptoms associated with what toxicity?

  1. Burning sensation during inspiration
  2. Pain during inspiration
  3. Cough
  4. Decreased pulmonary function
A

Pulmonary Oxygen Toxicity

37
Q

What is the treatment for Pulmonary Oxygen Toxicity?

A
  1. If patient cannot continue with respiratory discomfort, remove the patient from O2
  2. Consult DMO to modify treatments, increasing air time of air breaks between oxygen periods
38
Q

While conducting breath hold operations, oxygen PPO2 is higher at depth and during ascent the PPO2 decreases and increases the risk of hypoxia and unconsciousness in what?

A

Shallow Water Blackout

39
Q

What is the biggest risk of a shallow water black out?

A

Drowning

40
Q

What is the treatment for a shallow water blackout?

A
  1. In water: ventilation only, open airway, check breathing, provide 5 rescue breaths
  2. Do not attempt compressions in water
  3. Rule out cardiac arrest once on the boat/shore
  4. If patient is pulseless continue CPR utilizing ABC’s
  5. Transport to nearest ED
41
Q

What is indicated for a diver after a shallow water blackout who is showing no signs of pulse or respirations?

A

Immediate CPR and application of an AED

42
Q

True or False

Shallow Water Blackout

Access to ACLS is a higher priority than recompression

A

True

43
Q

What dive condition occurs during swimming or diving operations, often in young individuals with no predisposing conditions, and is believed to be related to exertion, immersion in cold water and overhydrating?

A

Swimming Induced Pulmonary Edema

44
Q

What are the following symptoms associated with?

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

Swimming Induced Pulmonary Edema

45
Q

What is the treatment for Swimming Induced Pulmonary Edema?

A
  1. Remove patient from the wet/cold environment
  2. Supplemental oxygen
  3. Complete heart/lung exam
  4. EKG
  5. X-ray within 24 hours **
  6. For critical patients, follow BLS/ACLS algorithms and transport to ED

CLASS 22010 DIVE (1 decks)

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