Diving Related Emergencies Flashcards
Which patients have a high probability of CAGE?
Pts with:
- GCS <15 and/or onset of symptoms <10-15mins after surfacing
- Any seizure
- LOC or ALOC
If cerebral arterial gas embolism suspected, consider…?
Air transport, preferably by helicopter at <300m.
List the signs and symptoms associated with DCI.
- Musculoskeletal pain
- Itching
- Any neurological changes
- Any respiratory complaint
What are the 8 elements of specific history taking that are important to ascertain for Diving Related Emergencies?
- Number of dives
- Surface interval between dives
- Maximum depths and bottom times
- Type of ascent (controlled/rapid)
- Decompression or safety stops
- Breathing gas mixture used
- Level of exertion during and after dive
- Presenting symptoms, first aid provided.
What needs to be done with divers computers/gauges from the dive?
Transport with pt to the facility.
What is the management for pts who have a GCS 15 and have been experiencing DCI symptoms for >12-24hrs?
Tx with a simple face mask with their gear to a recompression facility - they do not need high flow O2 via a NRB.
Where are the two proximal recompression facilities?
The Alfred Hospital and Royal Adelaide Hospital.
What are the primary goals for patients with a diving related injury?
Allow nitrogen to off-gas, increase O2 delivery and rehydrate.
What is the best way to remove nitrogen pre-hospitally?
High flow O2 delivery.
Unconscious and intubated pts must be ventilated using?
A BVM with 15L O2 if possible.
Post-immersion patients can have isolated hypotension. How is this managed?
Titrate fluid admin to pt response.
What is the issue with warming tissues in ?DCI?
Can result in dissolution of undissolved nitrogen. Pts should be warmed to less than 32 degrees only to avoid arrhythmia risk.
What position should potential CAGE pts be kept in?
Supine or lateral - do not allow to sit or stand.
If respiratory concerns, semi-recumbent is acceptable.
If there is an indication for opioid analgesia for ?DCI, consultation with the Alfred needs to occur - why?
Opioids may mask the symptoms for the receiving physician when assessing potential recompression Rx.
Which drug can mask the symptom of vertigo in ?DCI?
Stemetil.
What is a stable vs. unstable DRE pt?
GCS 15 or GCS <15.
What is the management for a symptomatic, stable DRE pt?
- Position supine/lateral
- Mx nausea
- O2 15L/min via NRB regardless of symptoms
- Avoid rapid body temp increases
- Tx to recompression chamber
- Mx other signs and symptoms
- Monitor for deterioration of GCS (Mx unstable)
- Fluid rehydration based on perfusion status
What is the management for a symptomatic, unstable DRE pt?
- Position supine/lateral
- Mx nausea
- O2 15L/min via NRB regardless of symptoms
- Avoid rapid body temp increases
- Tx to recompression chamber
- Mx other signs and symptoms
- Monitor for deterioration of GCS (Mx unstable)
- Fluid rehydration based on perfusion status
- Be aware of high risk of chest injuries
- Consider need for MICA/HEMS
When are MICA required for DRE pts?
If GCS <10, may require RSI.
What are the 2 fluid administration pathways under the DRE guidelines?
If adequately perfused and chest clear admin 20ml/kg of Normal Saline over 15-20mins. Continue at 1L per 4hrs.
If less than adequate perfusion, administer ambient Normal Saline 40ml/kg, titrate to response.
Consult the Alfred for further fluids, or if no consult avail. admin 20mL/kg Normal Saline.