MDT Flashcards by Chris Weber

What two gases are used by diver’s when at depth?

Nitrogen/helium

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If a diver ascends too fast the excess gas will separate from solution and form bubbles.

These bubbles produce mechanical and biochemical effects that lead to:

Decompression sickness

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Involves skin, lymphatic system, muscles, and joints

Joint pain outside the thorax: Knees, ankles, wrist

Skin itching and cutis marmorata (marbled bright red, purplish or even bluish pattern on the skin)

Swelling of the lymph nodes

DCS Type 1

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Treatment for DCS Type 1

Neuro exam to rule out AGE or DCS Type II

100% Surface Oxygen via non-rebreather

Transport to nearest Recompression Chamber

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Neurological Sx:
-Numbness, paresthesia’s, muscle weakness, mental status changes, impaired urinary function

Inner Ear Sx:
-Tinnitus, hearing loss, vertigo, dizziness, nausea, vomiting

Cardiopulmonary Sx:
-Chest pain, painful inspiration, irritating cough, tachypnea, lung congestion, complete circulatory collapse

DCS Type 2

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DCS Type 2 has symptoms in which three categories?

Neurological

Inner Ear

Cardiopulmonary

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Pain

Marbling of skin

Swelling of lymph nodes

DCS Type 1

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If a diving patient is transported by helicopter, maintain an altitude less than:

1000 ft

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Treatment for DCS Type II

Neuro exam to rule out AGE

100% Surface Oxygen via non-rebreather

Transport to nearest Recompression Chamber

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Occurs when gas is forced through torn lung tissue into the loose mediastinal tissues in the middle of the chest surrounding the heart, trachea, and major vessels

Pulmonary Over Inflation Syndrome

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Mild to moderate pain under the breastbone
Pain that radiates to the shoulder or back
Fullness around the neck and difficulty swallowing
Voice change
Palpation of the skin near the trachea may result in crepitus (cracking or crunching sound)

Mediastinal emphysema

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Treatment for mediastinal emphysema

Neuro exam to rule out AGE

Cardio/Lung exam to rule out pneumothorax

100% surface oxygen

Shallow recompression to 5-10 FSW may be warranted until symptoms resolve

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Caused by air leaking from tissues of the lungs into the space between the lungs and chest wall

Pneumothorax

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Pneumothorax

Onetime escape of gas

Simple pneumothorax

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Pneumothorax

Air continues to escape and collapses the lung which compromises cardiac function

Tension Pneumothorax

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Sudden, sharp chest pain

Shortness of breath

Labored breathing

Rapid heart rate

Weak pulse

Anxiety (impending doom)

Pneumothorax

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Treatment for Pneumothorax

Heart/lung exam

100% O2

Needle-decompression or chest tube

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Damage to body tissues from the mechanical effects of pressure, results when pressure differentials between body cavities

During a normal ascent and decompression procedures, these gases come out of the diver’s body at a manageable rate

Barotrauma

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Types of barotrauma

Ear squeeze

Sinus squeeze

Tooth squeeze

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Enables the diver to equalize pressure in the middle ear

Eustachian tube

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If the diver cannot equalize the pressure in the middle ear, the diver will experience a:

“Squeeze”

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A ear squeeze may result in:

TM rupture

Tissue damage

Cochlea/vestibular apparatus injury

Sharp pain in the ear

Rupture of the TM

Vertigo

Tinnitus

Hearing loss

Nausea/Vomiting

Ear squeeze (Barotrauma)

Treatment for ear squeeze barotrauma

HEENT exam

Decongestants

Pain medications

If a ruptured eardrum is suspected do not administer:

Medication directly into the ear canal

A diver's air supply can be contaminated by _______ when the compressor intake is placed to close to the compressor's engine exhaust

Carbon monoxide

Headache Dizziness Confusion Nausea Vomiting Tightness across the forehead

Carbon monoxide poisoning

Treatment for Carbon monoxide poisoning

Get the diver to fresh air 100% surface oxygen Transport to hyperbaric chamber

Definitive treatment of choice for carbon monoxide poisoning

Hyperbaric therapy

Abnormally high level of carbon dioxide in the blood and body tissues

Hypercapnia

Hypercapnia is generally the result of a buildup of carbon dioxide in what?

The breathing supply or an inadequate respiratory minute volume

- Increased breathing rate - Shortness of breath - Confusion or feelings of euphoria - Inability to concentrate - Increased sweating - Drowsiness - Headache - Loss of consciousness - Convulsions

Hypercapnia

Treatment for Hypercapnia

Decreasing the level of exertion to reduce CO2 production Increasing helmet and lung ventilation to wash out excess CO2 Shifting to alternate breathing source or aborting the dive if defective equipment is the cause

Exposure to a partial pressure of oxygen above that encountered in normal daily living

CNS Oxygen Toxicity

CNS oxygen toxicity The extent of the toxicity is dependent upon both the:

Oxygen partial pressure AND Exposure time

CNS Oxygen Toxicity The two areas of the body affected by Oxygen toxicity are the:

CNS and pulmonary system

- Tunnel vision, decreased peripheral vision, and other visual symptoms - Tinnitus - Confusion/Euphoria - Inability to concentrate - Increased sweating - Drowsiness - Headache - Loss of consciousness - Convulsions

CNS Oxygen Toxicity

Treatment for CNS Oxygen Toxicity

Immediately ascend Shift to a breathing mixture with lower oxygen percentage In a recompression chamber, remove oxygen mask and follow emergency procedures

Seriously interferes with the bloods ability to carry the oxygen required for the body to function normally

Carbon monoxide

The affinity of carbon monoxide for hemoglobin is ___ times that of oxygen

210

CO2 =

Carbon dioxide

Pulmonary oxygen toxicity, is sometimes called:

Low pressure oxygen poisoning

Can occur 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

Pulmonary oxygen toxicity

Burning sensation during inspiration Pain during inspiration Cough Decreased pulmonary function

Pulmonary oxygen toxicity

Treatment for Pulmonary Oxygen Toxicity

If the patient cannot continue with respiratory discomfort, remove the patient from O2 Consult DMO to modify treatments, increasing air time or air breaks between oxygen periods

While conducting breath hold operations, oxygen PPO2 is higher at depth. During ascent the PPO2 decreases and increases the risk of hypoxia and unconsciousness

Shallow water blackout

The biggest risk of shallow water black out is:

Drowning

Unconsciousness close to the surface or subsurface Hypoxia Subsequent drowning Cardiac/Respiratory arrest

Shallow water blackout

Treatment for shallow water blackout

In water: Ventilation, open airway, check breathing, provide 5 rescue breaths Do not attempt compression in the water Rule out cardiac arrest once on the boat/shore If the patient is pulseless continue CPR utilizing ABCs Transport to nearest ER

Indicated for a diver with no pulse or respirations

Immediate CPR and application of AED

Occurs during swimming or diving operations. Often in young individuals with no predisposing conditions Believed to be related to exertion, immersion in cold water or overhydrating

Swimmer Induced Pulmonary Edema (SIPE)

Dull to sharp substernal chest pain Hemoptysis (coughing up blood) Shortness of breath Frothy sputum

Swimmer Induced Pulmonary Edema

Treatment for Swimming Induced Pulmonary Edema

Remove patient from the wet/cold environment Supplement oxygen Complete heart/lung exam EKG X-ray within 2 hours For critical patients, use BLS/ACLS and transport to ER