Inside Tender Flashcards
Symptoms of Shock
- Irregular Breathing
- Vacant Eyes
- Dilated Pupils
- Clammy Skin
- Weak Pulse
- Low Blood Pressure
- Confusion
- Sweating
- Thirst
Treatment of Shock
- Maintain Breathing
- Control Bleeding
- Administer Oxygen
- Elevate lower extremities
- Avoid rough handling
- Keep Warm
- Lie Down
- Give nothing by mouth
What is the Strength Scale?
0) Paralysis - no movement
1) Profound Weakness - flicker and traces
2) Severe Weakness - able to move, but not overcome gravity
3) Moderate Weakness - able to over come gravity, but not examiner
4) Mild Weakness - able to resist slight force of examiner
5) Normal - equal strength bilaterally
Explain the Recovery Position?
Fetal position on the left side
3 types of bleeding control?
- Direct Pressure
- Pressure Points (13 of them)
- Tourniquet
What is the IV flow rate?
75 to 100 cc/hr
What are the 5 steps of a Neuro?
M ental Status
C oordination
M otor
C ranial Nerves
S ensory
D eep Tendon Reflexes
Urinary Output requirements?
0.5 cc/kg/hr
Pain descriptions?
Dull
Sharp
Throbbing
What are the 2 medkits and their locations and purpose?
Primary MedKit
Location: Inside Chamber
Purpose: Diagnostic
Secondary MedKit
Location: Outside of Chamber on the side
Purpose: Therapeutic
What are the 5 vitals?
- Breathing
- Pulse Ox
- Blood Pressure
- Temp
- Heart Rate
What are the two types of hypothermia and their treatments?
Regular Hypothermia
Tx: Active Rewarming
Severe Hypothermia
Tx: Passive Rewarming
What is the difference between severe and regular CO Poisoning?
If its noticeable its severe
What do you do for a patient having a seizure during a treatment table?
- Off O2
- Notify Topside
- Protect patient from hurting himself
what kind of IV’s can you use?
What should you avoid?
USE:
Lactated ringers
Normal saline
Avoid:
-Dextrose if brain or spinal cord injury is present
What is a barotrauma?
damage to body tissues caused by a difference in pressure between
a gas space inside, or in contact with the body, and the surrounding gas or fluid.
What are the symptoms of type 1 DCS
P-Pain
M-Marbling
S- Swelling of the lymph nodes
When could an individual start to feel the symptoms pulmonary oxygen toxicity?
Whenever the oxygen partial pressure exceeds 0.5 ata.
A 12 hour exposure to a partial pressure of 1 ata will produce mild symptoms and measurable decreases in lung function.
The same effect will occur with a 4 hour exposure at a partial pressure of 2 ata.
How do you treat a Tension Pneumothorax?
Insert mid-clavical line between 2nd and 3rd intercostal space on affected side.
14 gage, 3.25 in long
Vital sign ranges for BP, Breaths per min, Pulse oximetry, Temp, heart rate
BP-120/80 normal
Breaths- 12-20
Pulse Ox- 96-100
Temp- 98.6
Heart rate- 60-80 bpm
What is systolic and diastolic blood pressure?
Systolic: pressure created in the arteries when the heart pumps blood into circulation
Diastolic: pressure remaining in the arteries when the heart is relaxed
Systolic pressure is always reported first and then the diastolic
Symptoms of mediastinal emphysema
Substernal chest pain
tightness or dull ache in chest
pain radiating to shoulder or upper back
pain swallowing
coughing
When giving artificial ventilation, what should the rate of ventilation be?
10 to 12 breaths per minute or one every 5 seconds
What do you do for a near drowning?
ABCs
100% O2
Recovery position on left side because right lung with three lobes is relieved of pressure / in case of vomit
Keep warm
Monitor for need of CPR
Get to hospital
Mediastinal Emphysema
occurs when gas is forced into the loose mediastinal tissues
middle of the chest surrounding the heart
trachea
major blood vessels
At what ppO2 do individuals become hypoxic to the point of helplessness? Unconsciousness?
0.11 (helplessness)
- 0.10 (Unconsciousness)
What are techniques of artificial ventilation?
Mouth to mouth
Mouth to nose
Mouth to stoma (windpipe)
Mouth to mask
Hyperthermia Treatment
-reduce core temperature
mild to moderate:
remove clothing
spray with a mist/ fan
pack neck, pits, groin, with ice
Severe:
transport to medical
give IV during transport
Symptoms of Pneumothorax
sudden sharp chest pain
shortness of breath
weak pulse
increase heart rate
labored breathing
What will not be read by an AED and requires ACLS?
- Asystole (ay-sis-toll-lee)
- when your heart’s electrical system fails entirely, which causes your heart to stop pumping - Pulseless Electrical Activity (PEA)
- heart stops because the electrical activity in your heart is too weak to make your heart beat
Chamber temperatures
over 104
95-104
85-94
under 85
over 104- no treatments
95-104- 5,9 for 2 hours
85-94- 5, 6, 6a, 1a, 9 for 6 hours
under 84- all treatments
Pulmonary O2 poisoning when PP exceeds what ATA?
0.5 ATA
How to install OPA/NPA?
- Measure from tip of nose to tip of ear lobe
- Lube NPA with water soliable lube
- Insert NPA right nostril with bevel towards the septum
*if you have to insert left nostril face the bevel towards the septum and half way through rotate 180 to resume alignment.
CNS O2 toxictiy when PP exceeds what ATA for wet and dry?
Wet- 1.3 ATA
Dry- 2.4 ATA
Pulmonary Overinflation Syndromes (POIS)
Leaking of gas into the pulmonary interstitial tissue
When can you stop CPR?
- Signs of life
- Pronounced dead by a doctor
- Qualified person relieves you/ higher care
- AED shock
What are four means of keeping air way open?
- OPA oropharyngeal airway #4 and #5
- NPA nasal airways #32f and #34f
- Cricothyrotomy kit
- Alternative Emergency airway device
*Dive manual 17-8/17-9 table
Symptoms of subcutaneous emphysema?
- Fullness in throat
- Change in voice
- Rice Krispies (crepitus)
- Difficulty swallowing
Partial pressure of oxygen below what causes the onset of hypoxia?
0.16
Tourniquet/ hemorrhage control
- Direct pressure and pressure points first
- Use tourniquet as a last resort
- Put on high and tight
mark T on head and the time you put it on - Do not take off or loosen
5.Seek higher medical care and notify that you put on a tourniquet
What are the shockable rhythms an AED will read?
Ventricular Fibrillation (type of irregular pulse)
Pulsesless Ventricular Tachycardia (very rapid but ineffective contractions)
*both are types of arrhythmia (irregular heartbeat)
Subcutaneous Emphysema
A when that gas subsequently migrates into the subcutaneous tissues of the neck
What is the first step in pulmonary over-inflation?
Interstitial Emphysema:
-rupture of the alveolus with a collection of air in the lung tissues
CPR compression rate?
100 per min
30/2 as a rule of thumb
What are the three bones in the ear?
Malleus (hammer)
Incus (anvil)
Stapes (stirrup)
AGE
gas enters the arterial circulation, dispensing to all organs.
CNS and heart are especially susceptible
Would a simple eye twitch be considered a neurological disorder?
No, because simple eye twitch is common with large amounts or people sensitive to caffeine, fatigue, and stress.
What is the medical procedure of suction?
clearing obstructions of breathing such as vomit or blood through a suction device.
Symptoms of AGE/ type 2 DCS
u- unconsciousness
w-weakness
p-paralysis
n-numbness
e-ears ringing roaring
b- blurred vision
d- dizziness
f- fatigue
p- pins and needles
What is the flow rate for a Bag Valve Mask (BVM)?
15 liters per min
- bag is about 1 liter
Symptoms of CNS 02 toxicity
V- visual symptoms
E- ears ringing and roaring
N- nausea / vomiting
T- TWITCHING
I- Irritability
D- Dizziness
C- Convulsion
Symptoms of Pulmonary 02 Toxicity
C- Cough/ Severe
B- Breathing pain while inhaling
S- Substernal chest pain/ burning
Needle Thoracentisis
14 gauge by 3.25 inch cathiter
Insert mid clavicle line between 2nd and 3rd intercostal space of affected side.
Always insert over the rib
Pneumothorax
Air trapped in the pleural space between the lung and the chest wall
What is the POIS tree?
Anatomy of the ear? Draw
How much and what should a patient drink during a treatment table?
1-2 liters of water, juice, or non-carbonated over the course of a treatment
What are the tender oxygen breathing requirements?
All stops at 30FSW and breathing on ascent from 30FSW
TT5
Without extensions :00 (* :20)
With extensions :00 (* :20)
TT6
Without extensions :30 (* :90)
With extensions :60 (* :120)
TT6A
Without extensions :60 (* :120)
With extensions :90 (* :150)
*if tender has previous hyperbaric exposure within 18hrs
What are the 6 tests for coordination?
- Walk
- Heel-to Toe
- Romberg
- Finger-to-Nose
- Heel Shin Slide
- Rapid Movement
What are the 4 Deep Tendon Reflexes?
- Bicep
- Tricep
- Knee
- Ankle (Achilles)
What are the questions to remember for mental status?
Red Ball
Green Tree
Couch
Spell “world” backwards
Count backwards from 100 by 7
(93,86,79,72)
What is the I cranial nerve and function?
OLFACTORY
- smell
What is the II cranial nerve?
OPTIC
- vision
What is the III cranial nerve?
OCULOMOTOR
- controls eye movements along with TROCHLEAR (IV) and ABDUCENS (VI)
What is the IV cranial nerve?
TROCHLEAR
- Eye movements along with the OCULOMOTOR (III) and ABDUCENS (VI)
What is the V cranial nerve?
TRIGEMINAL
- sensation of the forehead, face and clenching of jaw
What is the VI cranial nerve?
ABDUCENS
- eye movements along with OCULOMOTOR (III) and TROCHLEAR (IV)
What is the VII cranial nerve?
FACIAL
- controls face muscles
What is the VIII cranial nerve?
ACOUSTIC
- hearing and balance
What is the IX cranial nerve?
GLOSSOPHARYNGEAL
- sensation from upper mouth and throat area
What is the X cranial nerve?
VAGUS
- control of roof of mouth and vocal cords
What is the XI cranial nerve?
SPINAL ACCESSORY
- turning head side to side and shoulder shrug with resistance
What is the XII cranial nerve?
HYPOGLOSSAL
- controls the tongue
What are the 6 factors known to affect the Risk of CNS O2 Toxicity?
- Individual Susceptibility
(increases or decreases risk) - CO2 Retention
(hypercapnia increases rick by increasing brain blood flow affecting brain O2 levels) - Exercise
(increases risk) - Immersion in Water
(unknown why, but increases risk) - Depth
(increases risk) - Intermediate Exposure
(decreases risk)
Do you press a pulseless diver?
A pulseless diver should not be compressed unless there is no possibility of evacuation. Unless ABCs are restored, the diver will likely die.
Is the AED allowed to be used in the chamber?
No
4 types of thermometers for the chamber?
A lcohol
B i-metallic
L iquid Crystal
E electric
What are the types of IV fluid?
- Isotonic (same or very similar solution of solute)
Ex: normal saline or lactated ringers - Hypotonic (lower concentration of solute)
Ex: distilled water - Hypertonic (higher concentration of solute)
Ex: high sodium drinks
What does ACLS stand for?
Advanced Cardiac Life Support
What is the flow rate for surface o2?
15 liters / min
When is the only time the patient should be kept awake during treatment?
During O2 periods at depths greater than 30 FSW
When can food be eaten in the chamber?
Anytime
What do you ask for history before a neuro?
S igns/Symptoms
A llergies
M edication
P revious Symptoms
L ast time victim ate/drank
E vents preceding problem
What is the blood flow through the heart?
Body>right atrium>right ventricle>lungs>left atrium>left ventricle>body
Whatis the blood flow through the body?
heart>aorta>arteries>arterioles>capillaries>venoules>veins>superior/inferior vena cava>heart
What is the acronym for hypoxia?
WILLDEALL
What are the respiration phases?
- ventilation of lungs
- exchange of gases between blood and air
- transport of gases by blood
- exchange of gases between blood and tissue fluid
- exchange of gases between tissue fluids and cells
- use and production of gases by cells
*air in lungs>gas to blood>gas to tissue fluid>tissue to cell>cell to body
What is the acronym for hypercapnia?
ICHILD
What is the acronym for CO poisoning?
Tiny
Headhunters
Practice
Ninja
Chicken
Voodoo
What are the symptoms of near drowning?
Unconcious
Pulmonary Edema
Increased RR
Most common barotrauma?
Middle Ear Squeeze
Primary symptoms of IEB?
Hearing loss and PERSISTENT vertigo
What is the acronym for AGE/ Severe DCS?
Underwater People Need Extremely Big Drinks To Party
What is the treatment of a pneumothorax?
BOTH:
100% O2
Neuro to rule out AGE
Simple:
trapped air will naturally reabsorb
Tension:
Chest tube or large bore catheter
Treatment for Mediastinal/Subcutaneous Emphysema?
100% O2
Neuro to rule out AGE and pneumothorax
Shallow water Decompression by UMO only
What is the treatmet for O2 absorption syndrome (Draeger Ear)?
Valsalva
What is ABC?
Air Breathing Circulation
When is a neurological exam required?
When diving related issues are suspect
What are you checking on a IV bag?
- No discoloraton
- Nothing floating
- Time administered
- Bag #
What is needle thoracentesis?
Needle D
What is required to start an IV?
- Needle
- IV Solution
- Tourniquet
- Transfer tube
- Guaze
- Cleaning swap
When is an IV required?
if the patient isn’t peeing .5cc/kg/hr or can not pee or ingest (unconscious)
When MUST you breath air in the chamber?
Deeper than 45 FSW, 1 person must breath air
What is the off O2 effect?
1-2 min after O2 you can still susceptible to a O2 hit
What is the first and primary duty of an IT?
DO NO HARM
What info must be put on the IV after being administered?
Date/Time, Person Administering, Bag#
What is the treatment of CO poisoning?
100% O2
transport to chamber or a medical facility
SEVERE (change in mental state, neurological symptoms, severe headache)
use TT6
How to treat Cardiac Arrest in the chamber?
- CPR
- Bring the diver to the surface
- ACLS
- Press someone for qualified with patient
What is a Myringotomy?
a procedure to create a hole in the ear drum to allow fluid that is trapped in the middle ear to drain out
UMO’s job
O2 and CO2 limits in chamber?
O2
19-25%
CO2
1.5 SEV
3 tests that cant be done in the chamber?
- Rhomberg
- Walk Normal
- Heel-Toe-Walk
