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
General Hypothermia dx - more severe shivering is in... - mental status changes c/...
- c/ lesser degrees of hypothermia | - more severe degrees of hypothermia
30
Mild hypothermia s/s
- answer ?'s intelligently - complains of cold - rewarms quickly
31
s/s's moderate hypothermia
- shivering is present - minor changes in mental status - incoordination
32
Severe hypothermia s/s
- severe mental status changes - cardiac arrhythmia's - cardiac arrest * obtunded - state of dumbness
33
Do not active rewarm... risk of ___.
- severely hypothermic pt's | - afterdrop
34
- avoid ___ & ___ drinks - Warm fluids PO c/... - NPO c/ - treat until Pt is...
- alcohol and caffeine (natural diuretics) - mild hypothermia - moderate or severe hypothermia - sweating
35
What do rewarmed hypothermic Pt's die from?
Septic shock after rewarming.
36
Passive external rewarming
- remove wet clothes - wrap c/ warm wool blanket - protect from wind/enviroment - place in warm area
37
Active rewarming techniques
- warm shower - place in very warm place - heat packs - warm IV fluids - bath
38
Thermal Protection c/ diving -
- wet suit - dry suit - hot H2O suit
39
What happens to your cells that get too hot @ a molecular level with Heat injuries?
i dont know
40
Heat stroke occurs @ temps >___ F
104.9 F
41
Classification of hyperthermia - mild to moderate - severe
- heat exhaustion | - severe heat stress or heat stroke
42
c/ heat and cold injuries the core temp is a tool but focus on changes in...
mental status
43
Check for ___ BP with heat injury Pt's
Orthostatic
44
mild to moderate | hyperthermia tx
- remove Pt from environment - cool Pt c/ spraying and farming c/ H2O - oral fluids - IV 1-2L NS - Rest
45
2 types of heat stroke
classic - common c/ elderly and children | external - from active life style
46
Heat stroke tx:
- 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
Occurrence of heat stroke may predispose to ___.
recurrence
48
MARGE GRAVE
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
- all bubbles have ___ ___ so they can be trapped even s/ a complete seal. ie. Pt has exostosis in their EAC
surface tension
50
- tensor tympani Fx | - stapedius muscle Fx
- 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
External ear barotrauma: - s/s - tx
- ear px c/ descent - decreased hear or loss until pressure is equalized - EAC Hemorrhage - stop descent - relieve obstruction - treat for OE if present
52
Pre tx all barotraumas for ___ ___ in anticipation of it occurring.
Otitis externa
53
``` MEB - s/s - tx NPQ dive c/ mild - mild - mod - severe/perf ```
``` - 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
MEB tx
systemic/topical decongestants antibiotics if perf'd contact ENT PRN
55
c/ divers its recommended to use ___%___ or ___%___ instead of OTC ear drops because our ears are wet too often
50% alcohol / 50% vinegar
56
TEED Scale create it
saf'sfj
57
Lambs test
asfa'sdfasdfj'kds
58
A MEB can progress to a ___.
IEB
59
IEB: | - s/s
- 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
IEB - tx Best way to differentiate an IEB from AGE & DCS?
- r/o AGE & DCS - Bed rest (consider sedation) - avoid straining - ENT consult - thorough hx
61
Sinus Barotrauma predisposing factors (3)
- infection (URI) - Allergy - Anatomic Variations (Polyps, mucus retention)
62
Sinus Barotrauma - s/s - tx
- sinus px c/TTP upon percussion dental px blood in face mask - NPQ dive decongestants observe for infection
63
Barodontalgia - #1 predisposing factor - s/s's - tx
- recent dental work - tooth px a pinpoint from px maxillary sinus px damage tooth - px management dental consult
64
Abdominal Barotrauma (rare) - cause - s/s - tx
- effervescent antacids prior to dive - abdominal px distention - ???
65
light headedness vs vertigo
dizziness vs spinning sensation
66
Vertigo: - most common on descent - most common on ascent - can occur on descent c/ a forceful valsalva
- caloric vertigo - ABV - ABV
67
- Draeger Ear is AKA... | - how to tx & prevent
- middle ear O2 absorption syndrome | - valsalva, prevent by valsalva periodically during and after the dive.
68
Facial Baroparesis is AKA... How does it occur?
- alternobaric facial palsy | - increase in middle ear pressure decreases blood flow to the facial nerve then ischemic neuropraxia
69
Facial Baroparesis | -s/s
- MEB c/ ear fullness, pressure or px, and may also have an URI - quick onset of one sided decrease sensation (face & tongue)
70
Facial Baroparesis: | -tx
- oral/topical decongestants - valsalva - contract pharyngeal muscles (valsalva) *goal is to equalize the middle ear
71
#1 way to differentiate hypoxia from hypercapnia is to ___ ...
check for cyanosis. Also consider DDTRRS