Enviromental

Question 1

Dive injuries

list

Answer 1

1. Barotrauma of descent - otic barotrauma, sinus barotrauma, inner ear barotrauma
2. Barotrauma of ascent - pulmonary barotrauma, AGE
3. Decompression sickness
4. Immersion pulm oedema
5. O2 toxicity
6. Nitrogen narcosis

Question 2

Decompression sickness type 1

Answer 2

Pain only
Joints and extremities
Skin changes - mottling, pruritus

Question 3

Inner ear barotrauma
when?
symptoms
Mx

Answer 3

on descent, forced valsava
sudden onset sensorineural hearing loss, tinnitus, severe vertigo.
Mx - head up, bed rest, avoid sneezing/ blowing nose, meds for vertigo, urgent ENT for exploration
Need emergency tympanostomy if going for hyperbaric

Question 4

Otic barotrauma
Sx
Mx

Answer 4

pain, fullness, vertigo
on descent, sometimes ascent
TM hemorrhage/ rupture
Mx - analgesia, decongestant, consider Abx

Question 5

Decompression sickness type 2

Answer 5

Serious
Pulmonary - cough/ dyspnoea/ haemoptysis/ chest pain
CV - can cause CV collapse
Neuro - truncal constriction, ascending paralysis
vestibular - vertigo, tinnitus, hearing loss

Question 6

Treatment of decompression sickness/ AGE

Answer 6

ABC
Supine position
100% O2
IV fluids
Rapid recompression
(Consider IV lignocaine for AGE (not DCS))

Question 7

Hypothermia classification

Answer 7

Mild - 32-35
conscious, shivering

Moderate 28-32
Impaired LOC, AF/ arrhythmia

Severe <28
Unconscious
Vital signs present

Hypothermic arrest

Question 8

Mx of hypothermic cardiac arrest

Answer 8

As per ACLS but…
Assess breathing and pulse 60 secs
standard protocols for 3 shocks and initial drugs then withold further shocks/ drugs until >30
Once >30, double dosing intervals of drugs
Continue until >32
Continue rewarming during resus
Consider transfer to ECMO centre

Question 9

Methods of warming

Answer 9

Passive rewarming
For mild 32-35
Remove wet clothing, warm blankets

Active external rewarming
For moderate 28-32
External heat application

Active internal rewarming
For severe <28
Warmed humidified O2, warmed IVV, Body cavity lavage, ECMO

Question 10

Poor prognosis in hypothermia

Answer 10

K>10
Core temp <6
Core temp <15 and no circulation for 2h
pH <6.5
Large intracranial thrombus on ECHO
Severe coagulopathy
Failure to obtain venous return in CP bypass
Hypothermic blunt trauma if temp <32, absent vital signs

Question 11

Heat stroke definition

Answer 11

Core temp >40
End organ injury, usually Neurological
(absent sweating)

Question 12

Types of cooling

Answer 12

Evaporative - remove clothing, spray with cool water, fan
Immersion
Ice packs
Cool blankets
Invasive cooling
Intubate and paralyse
CP bypass