MDT Flashcards
What two gases are used by diver’s when at depth?
Nitrogen/helium
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
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
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
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
DCS Type 2 has symptoms in which three categories?
Neurological
Inner Ear
Cardiopulmonary
Pain
Marbling of skin
Swelling of lymph nodes
DCS Type 1
If a diving patient is transported by helicopter, maintain an altitude less than:
1000 ft
Treatment for DCS Type II
Neuro exam to rule out AGE
100% Surface Oxygen via non-rebreather
Transport to nearest Recompression Chamber
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
- 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
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
Caused by air leaking from tissues of the lungs into the space between the lungs and chest wall
Pneumothorax
Pneumothorax
Onetime escape of gas
Simple pneumothorax
Pneumothorax
Air continues to escape and collapses the lung which compromises cardiac function
Tension Pneumothorax
Sudden, sharp chest pain
Shortness of breath
Labored breathing
Rapid heart rate
Weak pulse
Anxiety (impending doom)
Pneumothorax
Treatment for Pneumothorax
Heart/lung exam
100% O2
Needle-decompression or chest tube
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
Types of barotrauma
Ear squeeze
Sinus squeeze
Tooth squeeze
Enables the diver to equalize pressure in the middle ear
Eustachian tube
If the diver cannot equalize the pressure in the middle ear, the diver will experience a:
“Squeeze”
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
