Hints Flashcards
A patient comes out of the water after a 60 for 60 dive, and 2 hours later has pain in his ribcage at the joint between his ribs and sternum. What type of DCS is this and how is it treated?
This is likely T1DCS, but there is a possibility that this represents “girdle pain” and is due to spinal cord involvement, thus it should be treated as T2DCS. It should be a TT6 with full extensions.
Describe the characteristics of cutis Marmorata.
T1DCS often thought to be a harbinger of worse disease, and thus treated as T2.
- Deep red/purple mottling
- Blanching with pressure
- May be pruritic
- May spread peripherally and become erythematous.
Patient completes a deep bounce dive on Mk-16 with HeO2 and upon reaching the surface has significant vertigo and tinnitus but no other symptoms of DCS. His neuro exam is notable for vertical nystagmus. What does he have and what effect does this have on the diver’s career?
This is Inner Ear DCS - aka “the staggers.” As compared to inner ear barotrauma, there is no history of rapid descent or inner ear issues. Staggers are associated with mixed gas operations and saturation dives. This person should never dive again due to endosteal bone layers developing causing obstruction and this set of symptoms.
Describe the grades of the TEED scale and what it is used for.
TEED scale is used for classification of inner ear barotrauma. Symptoms are pain on descent, transient conductive hearing loss, blood in face mask, transient vertigo and tinnitus.
GO = Symptoms without signs
G1 = Redness and retraction of TM
G2 = G1 plus slight hemorrhage within TM
G3 = G1 plus gross hemorrhage within TM
G4 = Dark TM with bulging
G5 = Free hemorrhage into middle ear with perf.
What are the signs and symptoms of nitrogen narcosis?
Loss of judgement or skill False sense of well being Lack of concern for safety Apparent stupidity. Inappropriate laughter Tingling/numbness of lips/gums/legs.
What are the symptoms associated with CNS O2 toxicity?
VENTID-C Vision - tunnel vision, blurring Ears - ringing, roaring Nausea - or vomiting Tingling/twitching - face, lips, extremities Irritability - confusion, agitation, anxiety Dizziness - also loss of coordination Convulsions
What are the ideal temperatures (aka warm or cold) for bottom and decompression.
Cold on Bottom, warm during decompression.
If a patient has a notable heat injury, including pre-syncopal symptoms, collapse, and confusion but they are still sweating, can this still be a heat stroke?
Heat stroke is defined by rectal temperature; absence of sweating does not define heat stroke.
What are the steps to treatment for a Portuguese man-of-war injury.
1: Remove tentacles
2. Remove nematocysts with copious rinse with SALTWATER.
3. immerse in hot water for 20 mins because venom is heat labile
4. consider topical anesthetic or steroids.
The blue ringed octopus has what type of toxin and how does it work?
Toxin is a tetrodotoxin - identical to puffer fish toxin. It is a neuromuscular blocking agent and is NOT heat labile.
What is the cause of sea-bathers eruption?
Sea lice - the larvae of thimble jellyfish; painful, itching rash in bathing suit distribution. Note this is in Seawater.
What is the cause of swimmer’s itch?
Shistosome larvae in freshwater; maculopapular and pruritic eruptions in exposed areas.
A diver using the MK25 presents the morning after a dive complaining of L-ear pain, hearing loss and crackling sounds. He denies issues clearing, pain or vertigo the day before. Physical exam shows mildly retracted TM and very small effusion.
What is this called?
What is the treatment?
Draeger Ear i.e. Middle Ear Oxygen Absorption syndrome.
repeated middle pressure equalization/valsalva
*occurs on oxygen dives when O2 fills middle ear and is later absorbed causing negative pressure differential in middle ear.
At what PpO2 do symptoms of hypoxia typically begin?
What about unconsciousness?
PPO2 ~ 0.16 ATA
PPO2 ~0.10
At what depth does nitrogen narcosis typically begin to present?
100 FSW (4ATA)
