Diving Manual Chapter 17 Flashcards
what is the minimum manning level for recompression treatments?
- chamber supervisor
- inside tender / DMT
- outside tender
for an emergent diving injury what is the absolute minimum number of personnel for treatment?
- chamber supervisor
2. inside tender / DMT
AGEs are treated with initial compression to ___ fsw
60
if AGE symptoms are improved within the first oxygen breathing period at 60 fsw, then treatment is continued using Treatment Table ___
6
if AGE symptoms are unchanged or worsen within the first oxygen breathing period at 60 fsw, then what do you do?
- assess patient upon descent
- compress to depth of relief NTE 165 fsw
what % of DCS symptoms occur within 1 hour?
42%
what % of DCS symptoms occur within 3 hours?
60%
what % of DCS symptoms occur within 8 hours?
83%
what % of DCS symptoms occur within 24 hours?
98%
42% of DCS symptoms occurs within ___ hour(s)
1
60% of DCS symptoms occurs within ___ hour(s)
3
83% of DCS symptoms occurs within ___ hour(s)
8
98% of DCS symptoms occurs within ___ hour(s)
24
how does type I DCS manifest?
PAIN only:
- joints
- MSK
- skin
- swelling / pain of lymph nodes
what are the hallmark characteristics of type I DCS pain?
- dull
- achy
- confined to particular areas
- always present at rest
- usually unaffected by movement
how long is a patient monitored after treatment for pain-only symptoms?
2 hours
how long is a patient monitored after treatment for serious symptoms?
6 hours
what is the most common manifestation of DCS?
itching
do you need to recompress for itching?
no
do you need to recompress for faint skin rash?
no
do you need to recompress for mottling / marbling of the skin (cutis marmorata)?
yes
what do you do if a full neuro exam is not completed before initial recompression?
treat as type II DCS
what is done if a UMO decides that pain is related to specific orthopedic trauma or injury?
- use treatment table 5 (if a UMO is consulted)
- use treatment table 6 (if UMO is not consulted)
type II DCS is divided into what categories?
- neurological
- inner ear
- cardiopulmonary
how is inner ear DCS differentiated from neuro (cerebellar) DCS?
nystagmus is typically not present in cerebellar DCS
how does type II DCS differ from AGE?
time course - AGE symptoms typically occur within 10 minutes of surfacing
is treatment table 5 an appropriate treatment for symptomatic omitted decompression?
no
what do you do for a diver with symptomatic omitted decompression who surfaced from 50 ft or shallower?
compress to 60 fsw and begin treatment table 6
what do you do for a diver with symptomatic omitted decompression who surfaced from deeper than 50 ft?
- compress to 60 fsw or the depth where the symptoms are significantly improved (NTE 165 fsw)
- begin treatment table 6
what do you do if joint point is present but resolved before reaching 1 ata from altitude?
treat with 2 hours of 100% oxygen breathing at the surface followed by 24 hours of observation
what are the basic rules to be followed for all recompression treatments?
- compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow
- allow sufficient time for bubble resorption
- increase blood oxygenation content and thus oxygen delivery to injured tissues
which are more effective - air treatment tables or oxygen treatment tables?
oxygen
what are the options if a chamber is not available?
- transport to nearest chamber
- in-water recompression
*administer 100% oxygen during transport
what are the recommendations for patient transport to a nearby chamber?
- supine
- head up
- keep warm
- 100% oxygen
- constant monitoring
if a patient is moved by helicopter or other unpressurized aircraft, the aircraft should be flown as low as safely possible, preferably less than _____ ft
1000 ft
when can in-water recompression be initiated?
if there is no benefit with 100% oxygen at the surface after 30 minutes
when are air treatment tables 1A, 2A, and 3 used?
only as a last resort when oxygen is not available
when is treatment table 5 used?
- type I DCS
- asymptomatic omitted decompression
- treatment of resolved symptoms following in-water recompression
- follow-up treatments for residual symptoms
- CO poisoning
- gas gangrene
when is treatment table 6 used?
- AGE
- type II DCS
- type I DCS where relief is not complete within 10 minutes at 60 feet or where pain is severe and immediate recompression must be instituted before a neuro exam can be performed
- cutis marmorata
- severe CO poisoning
- cyanide poisoning
- smoke inhalation
- asymptomatic omitted decompression
- symptomatic controlled ascent
- recurrent of symptoms shallower than 60 fsw
what is the VENTID-C mnemonic for oxygen toxicity symptoms?
V - vision E - ears N - nausea T - twitching / tingling I - irritability D - dizziness C - convulsions
CNS oxygen toxicity is unlikely in resting individuals at chamber depths of ___ feet or shallower and very unlikely in resting individuals at chamber depths of ___ feet or shallower, regardless of the level of activity
- 50
- 30
what are the options for treatment of residual symptoms for persistent type II DCS?
- daily TT 6
- BID TT 5 or 9
