Diving Related Injuries and Treatment

Question 1

3 Objective of Recompression Treatment

Answer 1

1) Compress gas bubbles
2) Allow for bubble re-absorption
3) Increase ppO2 (through tissue and blood oxygen)

Question 2

TT5 Indications

Answer 2

Type I DCS relieved within 10 minutes
Asymptomatic omitted decompression
Follow-up treatments for residual symptoms
Treatment of resolved symptoms following in-water recompression
Gas gangrene
CO Toxicity

Question 3

TT6 Indications

Answer 3

Type I DCS not relieved within 10 minutes (cutis marmorata)
Type II DCS
Asymptomatic Omitted Decompression
Recurrence of symptoms shallower than 60 fsw
AGE
Severe Carbon Monoxide poisoning
Cyanide poisoning
Smoke inhalation
Symptomatic following treatment of in-water DCS
Symptomatic during SI of SURD

Question 4

TT6A Indications

Answer 4

Symptomatic blow up from >60 fsw

Worsening or unchanged AGE/Type II DCS symptoms at 20 minutes at 60 fsw

Question 5

POIS Definition

Answer 5

Expansion of gas trapped in the lung during ascent with over expansion and rupture of alveolar air sacks

Question 6

Types of POIS

Answer 6

Mediastinal emphysema, Subcutaneous emphysema, AGE, Pneumothorax

Question 7

AGE Definition

Answer 7

Alveolar rupture with air injected into capillary then from pulmonary veins to left ventricle and is pumped into systemic arteries.
- Brain is most significant site of an embolus, like CVA

Question 8

Time course of DCS

Answer 8

• 60% presents < 3 hrs
• 83% presents < 8 hrs
• 98% presents < 24 hrs
• CNS DCS may have shorter latency (90% symptomatic <3hrs)

Question 9

NIggles

Answer 9

odd fleeting aches and pains
may herald typical limb pain DCS
treat as Type I DCS

Question 10

Type 1 Pain treated as type II

Answer 10

Cutis Marmorata

Thoracic/abdominal pain

Question 11

Spinal DCS

Answer 11

• Associated with short, deep dives
• Area of damage most commonly in anterior horn
• White matter more affected

Question 12

Manifestations of cerebral DCS

Answer 12

• Motor Deficits
• Sensory Changes
• Personality Changes
• Memory Loss
• Acute Psychosis
• Loss of coordination
• Ataxia
• Extreme Fatigue

Question 13

Type II DCS Select Ocular Manifestations

Answer 13

• Nystagmus
• Diplopia
• Visual Fields (VF) Defects
• Scotomata
• Homonymous Hemianopsia
• Central Retinal artery occlusion
• Optic Neuropathy
• Ocular Muscle impairment
• Eyelid muscle pain

Question 14

Symptoms of Hypercapnia

Answer 14

• Rapid pulse and respiration
• Unconsciousness
• Dizziness
• Eyes burning
• Progressive Mental Confusion
• Headache
• SOB

Question 15

Mechanism of CO, Cyanide, and sulfide Toxicity

Answer 15

These toxicities decrease the likelihood of oxygen attaching to red blood cells via hemoglobin

Question 16

Contraindications for HBOT

Answer 16

Chronic Sinusitis
Congenital Spherocytosis
Emphysema with CO2 retention
History of optic neuritis
History of reconstructive ear surgery
History of spontaneous pneumothorax
History of thorax surgery
Seizure disorders
Sickle Cell Anemia
URI