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dmt > DMMP Topic 2 - Dive injuries > Flashcards

DMMP Topic 2 - Dive injuries Flashcards

1
Q

N2 Narcosis:

  • @ >180 fsw
  • @ > 300 fsw
A
  • no trust should be placed on human performance, except simple repetitive tasks.
  • orders may be ignored or LOC may occur
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2
Q

Abnormal gas problems (5)

A 
CO2 Tox
Hypoxia
O2 tox
CO tox
N2 Narcosis
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3
Q

When should hypoxia be assumed until r/o?

A

If a diver becomes unresponsive during a mixed gas dive.

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5
Q

Hypoxia sx’s typically begin @ ppO2

A

0.16 ata

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8
Q

Hypoxia Tx

A
  • Shift to alternate gas supply
  • administer 100% )2 at surface
  • r/o AGE
  • CPR
  • Contact DMO
  • Transport
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9
Q
  • CO2 tox H,A last usually ___.

- CO2 tox usually follows c/ ___ s/s.

A
  • > :30

- hypoxia s/s

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11
Q

What gas tox can occur s/ a deficiency of O2?

A

CO2 tox

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12
Q
  • c/ CO2 tox Pts r/o ___ first

- why?

A
  • hypoxia

- to ensure O2 to the brain.

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13
Q

CO2 Tox Tx

A
  • ventilate
  • decrease exertion
  • abort dive
  • Neuro r/o AGE
  • O2 100%
  • Transport
  • Contact DMO
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14
Q

CO tox is ___ x more affinitive to Hgb than O2

A

210

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15
Q

Hypercapnia Complications

A
  • Increases risk for N2 Narcosis, O2 tox, & DCS
  • Vasodilation can:
    • vessel walls become more permeable and then increase risk for O2 Tox.
    • platelet or plaque can break off during vasodilation the occlude smaller vessels.
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16
Q

N2 Narcosis increases susceptibility c/

A

CO2 levels, fatigue, rapid press, and hypothermia.

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17
Q
  • all s/s of CO tox are due to a lack of ___ to the ___.

- s/s may include any ___.

A
  • O2, brain

- neurological s/s

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18
Q

Why are CO tox Pt’s not cyanotic

A

because the Heme is bound c/ CO molecule which oxidizes c/ the Fe much like O2 does then CO’s mass binding results in a more flushed skin appearance.

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19
Q

CO tox tx

A
  • remove Pt from CO source
  • 100% O2 @ surface c/ mild sx’s
  • tx @ 60fsw on 100% O2 c/severe sx’s
  • recommended TT5 or 6 by DMO c/ max of 5 tx’s
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20
Q

Causes of CO2 tox c/ MK-25 (4)

A
  • absorbent failure
  • excessive activity @ depth
  • exceed canister duration
  • improper canister packing (channeling)
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21
Q

Procedures for CNS O2 tox hit during Re’C’ (NON CONVULSION)

  • 1st
  • 2nd
  • 3rd
A
  • remove O2, wait till all O2 sx’s subside, wait :15, continue O2 from point of interruption.
  • remove O2, wait till all O2 sx’s subside, decompress 10fsw at 1’/min, resume O2 at point of interruption.
  • d/c O2 tx contact DMO.
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22
Q

Procedures for CNS O2 hit during Re’C’ (convulsion)

  • 1st
  • 2nd
A
  • remove O2, wait for all sx’s to subside, ensure Pt is breathing relaxed and normally, decompress 10fsw at 1’/min. Resume O2 tx at point of interruption.
  • d/c O2 tx and contact DMO.
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23
Q

Ex’s that can cause Pulmonary O2 tox

A
  • 100% O2 UBA (ie. MK-25)
  • long TT’s on O2
  • hospital or nursing homes
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24
Q

Why does sx’s VENTTID-C occur c/ CNS O2 tox

Why does sx’s CBS occur c/ pulmonary O2 tox

A
  • so much O2 on board the body has to burn it off.

- O2 is corrosive and over long periods of time, the mucosa linings of naso, oro, trachea, and bronhci dry out.

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25
Q

Pulmonary O2 tox tx

What if during TT

A
  • contact DMO about removing O2
  • consider using a humidifier/nebulizer
  • c/ Re’C’ ops Pt’s may have to tolerate the sx’s if they have severe Neuro deficits.
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26
Q

Risk factors that increase chance of hypothermia (6)

A
  • fatigue
  • dehydration
  • malnutrition
  • disease
  • poor physical fitness
  • age
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27
Q

What is the difference between Aviator’s(diver) O2 and Medical O2?

A

Humidity level

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28
Q
  • dx of hypothermia is
A

-

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29
Q

General Hypothermia dx

  • more severe shivering is in…
  • mental status changes c/…
A
  • c/ lesser degrees of hypothermia

- more severe degrees of hypothermia

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30
Q

Mild hypothermia s/s

A
  • answer ?’s intelligently
  • complains of cold
  • rewarms quickly
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31
Q

s/s’s moderate hypothermia

A
  • shivering is present
  • minor changes in mental status
  • incoordination
32
Q

Severe hypothermia s/s

A
  • severe mental status changes
  • cardiac arrhythmia’s
  • cardiac arrest
  • obtunded - state of dumbness
33
Q

Do not active rewarm…

risk of ___.

A
  • severely hypothermic pt’s

- afterdrop

34
Q
  • avoid ___ & ___ drinks
  • Warm fluids PO c/…
  • NPO c/
  • treat until Pt is…
A
  • alcohol and caffeine (natural diuretics)
  • mild hypothermia
  • moderate or severe hypothermia
  • sweating
35
Q

What do rewarmed hypothermic Pt’s die from?

A

Septic shock after rewarming.

36
Q

Passive external rewarming

A
  • remove wet clothes
  • wrap c/ warm wool blanket
  • protect from wind/enviroment
  • place in warm area
37
Q

Active rewarming techniques

A
  • warm shower
  • place in very warm place
  • heat packs
  • warm IV fluids
  • bath
38
Q

Thermal Protection c/ diving

-

A
  • wet suit
  • dry suit
  • hot H2O suit
39
Q

What happens to your cells that get too hot @ a molecular level with Heat injuries?

A

i dont know

40
Q

Heat stroke occurs @ temps >___ F

A

104.9 F

41
Q

Classification of hyperthermia

  • mild to moderate
  • severe
A
  • heat exhaustion

- severe heat stress or heat stroke

42
Q

c/ heat and cold injuries the core temp is a tool but focus on changes in…

A

mental status

43
Q

Check for ___ BP with heat injury Pt’s

A

Orthostatic

44
Q

mild to moderate

hyperthermia tx

A
  • remove Pt from environment
  • cool Pt c/ spraying and farming c/ H2O
  • oral fluids
  • IV 1-2L NS
  • Rest
45
Q

2 types of heat stroke

A

classic - common c/ elderly and children

external - from active life style

46
Q

Heat stroke tx:

A
  • active cooling & tx to medical
  • remove clothes, spray & fan c/ H2O
  • place ICE packs (neck, groin, axilla)
  • Check ABC’s
  • 100% O2
  • Monitor SpO2
  • ECG
  • IV Access
  • Foley cath
47
Q

Occurrence of heat stroke may predispose to ___.

A

recurrence

48
Q

MARGE

GRAVE

A

Membrane lined space Gas filled space
Ambient pressure change Rigid walls
Rigid walls Ambient pressure change
Gas filled space Vascular penetration
Enclosed spaces Enclosed space

49
Q
  • all bubbles have ___ ___ so they can be trapped even s/ a complete seal.
    ie. Pt has exostosis in their EAC
A

surface tension

50
Q
  • tensor tympani Fx

- stapedius muscle Fx

A
  • dampens sounds ie. c/ chewing or going into a rock concert initially it’s too loud, then you become adjusted then when you leave there is a delay where you talk loud.
  • stabilizes the stapes. Its the smallest muscle in the body.
51
Q

External ear barotrauma:

  • s/s
  • tx
A
  • ear px c/ descent
  • decreased hear or loss until pressure is equalized
  • EAC Hemorrhage
  • stop descent
  • relieve obstruction
  • treat for OE if present
52
Q

Pre tx all barotraumas for ___ ___ in anticipation of it occurring.

A

Otitis externa

53
Q 
MEB
  - s/s
  - tx
NPQ dive c/ mild
  - mild
  - mod
  - severe/perf
A 
- Fullness or px
  transient loss of conductive hearing
  blood in face mask
  transient vertigo
  transient tinnitus
  TM perf if severe
- NPQ dive 
   8-72 hrs c/ mild to moderate
   1-8 days c/ moderate
   up to 6 wks c/ severe/perf TM

*recurrent Perf is common c/ resumed during too soon.

54
Q

MEB tx

A

systemic/topical decongestants
antibiotics if perf’d
contact ENT PRN

55
Q

c/ divers its recommended to use ___%___ or ___%___ instead of OTC ear drops because our ears are wet too often

A

50% alcohol / 50% vinegar

56
Q

TEED Scale create it

A

saf’sfj

57
Q

Lambs test

A

asfa’sdfasdfj’kds

58
Q

A MEB can progress to a ___.

A

IEB

59
Q

IEB:

- s/s

A
  • persistent vertigo
  • tinnitus
  • nystagmus c/ positional testing
  • bubbling sensation in the ear
  • neurosensory hearing loss (because the cochlea isn’t able to send the message)
  • otoscope shows MEB
60
Q

IEB
- tx

Best way to differentiate an IEB from AGE & DCS?

A
  • r/o AGE & DCS
  • Bed rest (consider sedation)
  • avoid straining
  • ENT consult
  • thorough hx
61
Q

Sinus Barotrauma predisposing factors (3)

A
  • infection (URI)
  • Allergy
  • Anatomic Variations (Polyps, mucus retention)
62
Q

Sinus Barotrauma

  • s/s
  • tx
A
  • sinus px c/TTP upon percussion
    dental px
    blood in face mask
  • NPQ dive
    decongestants
    observe for infection
63
Q

Barodontalgia

  • # 1 predisposing factor
  • s/s’s
  • tx
A
  • recent dental work
  • tooth px a pinpoint from px
    maxillary sinus px
    damage tooth
  • px management
    dental consult
64
Q

Abdominal Barotrauma (rare)

  • cause
  • s/s
  • tx
A
  • effervescent antacids prior to dive
  • abdominal px
    distention
  • ???
65
Q

light headedness vs vertigo

A

dizziness vs spinning sensation

66
Q

Vertigo:

  • most common on descent
  • most common on ascent
  • can occur on descent c/ a forceful valsalva
A
  • caloric vertigo
  • ABV
  • ABV
67
Q
  • Draeger Ear is AKA…

- how to tx & prevent

A
  • middle ear O2 absorption syndrome

- valsalva, prevent by valsalva periodically during and after the dive.

68
Q

Facial Baroparesis is AKA…

How does it occur?

A
  • alternobaric facial palsy

- increase in middle ear pressure decreases blood flow to the facial nerve then ischemic neuropraxia

69
Q

Facial Baroparesis

-s/s

A
  • MEB c/ ear fullness, pressure or px, and may also have an URI
  • quick onset of one sided decrease sensation (face & tongue)
70
Q

Facial Baroparesis:

-tx

A
  • oral/topical decongestants
  • valsalva
  • contract pharyngeal muscles (valsalva)

*goal is to equalize the middle ear

71
Q

1 way to differentiate hypoxia from hypercapnia is to ___ …

A

check for cyanosis.

Also consider DDTRRS

dmt (15 decks)

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