DMMP Topic 2 - Dive injuries Flashcards
N2 Narcosis:
- @ >180 fsw
- @ > 300 fsw
- no trust should be placed on human performance, except simple repetitive tasks.
- orders may be ignored or LOC may occur
Abnormal gas problems (5)
CO2 Tox Hypoxia O2 tox CO tox N2 Narcosis
When should hypoxia be assumed until r/o?
If a diver becomes unresponsive during a mixed gas dive.
Hypoxia sx’s typically begin @ ppO2
0.16 ata
Hypoxia Tx
- Shift to alternate gas supply
- administer 100% )2 at surface
- r/o AGE
- CPR
- Contact DMO
- Transport
- CO2 tox H,A last usually ___.
- CO2 tox usually follows c/ ___ s/s.
- > :30
- hypoxia s/s
What gas tox can occur s/ a deficiency of O2?
CO2 tox
- c/ CO2 tox Pts r/o ___ first
- why?
- hypoxia
- to ensure O2 to the brain.
CO2 Tox Tx
- ventilate
- decrease exertion
- abort dive
- Neuro r/o AGE
- O2 100%
- Transport
- Contact DMO
CO tox is ___ x more affinitive to Hgb than O2
210
Hypercapnia Complications
- 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.
N2 Narcosis increases susceptibility c/
CO2 levels, fatigue, rapid press, and hypothermia.
- all s/s of CO tox are due to a lack of ___ to the ___.
- s/s may include any ___.
- O2, brain
- neurological s/s
Why are CO tox Pt’s not cyanotic
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.
CO tox tx
- 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
Causes of CO2 tox c/ MK-25 (4)
- absorbent failure
- excessive activity @ depth
- exceed canister duration
- improper canister packing (channeling)
Procedures for CNS O2 tox hit during Re’C’ (NON CONVULSION)
- 1st
- 2nd
- 3rd
- 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.
Procedures for CNS O2 hit during Re’C’ (convulsion)
- 1st
- 2nd
- 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.
Ex’s that can cause Pulmonary O2 tox
- 100% O2 UBA (ie. MK-25)
- long TT’s on O2
- hospital or nursing homes
Why does sx’s VENTTID-C occur c/ CNS O2 tox
Why does sx’s CBS occur c/ pulmonary O2 tox
- 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.
Pulmonary O2 tox tx
What if during TT
- 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.
Risk factors that increase chance of hypothermia (6)
- fatigue
- dehydration
- malnutrition
- disease
- poor physical fitness
- age
What is the difference between Aviator’s(diver) O2 and Medical O2?
Humidity level
- dx of hypothermia is
-
General Hypothermia dx
- more severe shivering is in…
- mental status changes c/…
- c/ lesser degrees of hypothermia
- more severe degrees of hypothermia
Mild hypothermia s/s
- answer ?’s intelligently
- complains of cold
- rewarms quickly
s/s’s moderate hypothermia
- shivering is present
- minor changes in mental status
- incoordination
Severe hypothermia s/s
- severe mental status changes
- cardiac arrhythmia’s
- cardiac arrest
- obtunded - state of dumbness
Do not active rewarm…
risk of ___.
- severely hypothermic pt’s
- afterdrop
- avoid ___ & ___ drinks
- Warm fluids PO c/…
- NPO c/
- treat until Pt is…
- alcohol and caffeine (natural diuretics)
- mild hypothermia
- moderate or severe hypothermia
- sweating
What do rewarmed hypothermic Pt’s die from?
Septic shock after rewarming.
Passive external rewarming
- remove wet clothes
- wrap c/ warm wool blanket
- protect from wind/enviroment
- place in warm area
Active rewarming techniques
- warm shower
- place in very warm place
- heat packs
- warm IV fluids
- bath
Thermal Protection c/ diving
-
- wet suit
- dry suit
- hot H2O suit
What happens to your cells that get too hot @ a molecular level with Heat injuries?
i dont know
Heat stroke occurs @ temps >___ F
104.9 F
Classification of hyperthermia
- mild to moderate
- severe
- heat exhaustion
- severe heat stress or heat stroke
c/ heat and cold injuries the core temp is a tool but focus on changes in…
mental status
Check for ___ BP with heat injury Pt’s
Orthostatic
mild to moderate
hyperthermia tx
- remove Pt from environment
- cool Pt c/ spraying and farming c/ H2O
- oral fluids
- IV 1-2L NS
- Rest
2 types of heat stroke
classic - common c/ elderly and children
external - from active life style
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
Occurrence of heat stroke may predispose to ___.
recurrence
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
- all bubbles have ___ ___ so they can be trapped even s/ a complete seal.
ie. Pt has exostosis in their EAC
surface tension
- 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.
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
Pre tx all barotraumas for ___ ___ in anticipation of it occurring.
Otitis externa
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.
MEB tx
systemic/topical decongestants
antibiotics if perf’d
contact ENT PRN
c/ divers its recommended to use ___%___ or ___%___ instead of OTC ear drops because our ears are wet too often
50% alcohol / 50% vinegar
TEED Scale create it
saf’sfj
Lambs test
asfa’sdfasdfj’kds
A MEB can progress to a ___.
IEB
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
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
Sinus Barotrauma predisposing factors (3)
- infection (URI)
- Allergy
- Anatomic Variations (Polyps, mucus retention)
Sinus Barotrauma
- s/s
- tx
- sinus px c/TTP upon percussion
dental px
blood in face mask - NPQ dive
decongestants
observe for infection
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
Abdominal Barotrauma (rare)
- cause
- s/s
- tx
- effervescent antacids prior to dive
- abdominal px
distention - ???
light headedness vs vertigo
dizziness vs spinning sensation
Vertigo:
- most common on descent
- most common on ascent
- can occur on descent c/ a forceful valsalva
- caloric vertigo
- ABV
- ABV
- Draeger Ear is AKA…
- how to tx & prevent
- middle ear O2 absorption syndrome
- valsalva, prevent by valsalva periodically during and after the dive.
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
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)
Facial Baroparesis:
-tx
- oral/topical decongestants
- valsalva
- contract pharyngeal muscles (valsalva)
*goal is to equalize the middle ear
1 way to differentiate hypoxia from hypercapnia is to ___ …
check for cyanosis.
Also consider DDTRRS
