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KIN 424 - Medical Aspects of Sport > Module 3 - Physiology and Medicine of Diving and Immersion > Flashcards

Module 3 - Physiology and Medicine of Diving and Immersion Flashcards

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1
Q

What are the types of Hyperbaric Exposures?

A
  • SCUBA diving
  • Rebreathers
  • Umbilical (surface supply) device
  • Hyperbaric Chamber Exposure
  • Breathhold/Free Diving: Pearl Divers; Syncro Swimmers
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2
Q

Describe SCUBA Diving

A

Breath air or gas from a tank and it goes to the environment
- Open Circuit
- Expired Gases Released
- Bubbles

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3
Q

Describe Rebreathers

A

Uses Same gas, more than once, good for stealth
- Apparatus
- Closed Circuit
- No Bubbles Exhausted
- Rarely used by Civilians

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4
Q

Describe Umbilical/Surface Supply diving

A

old-timey diving
- connection from diver and ship
- air pumped from above water
- exclusively used by commercial divers
- long duration

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5
Q

Describe a JIM suit

A

Mix between exoskeleton and personal submarine
- surface rigid
- pressure inside different from pressure outside
- Dexterity and mobility reduced

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6
Q

Describe Free Diving

A
  • Single Breath
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7
Q

When is Free Diving used?

A
  • Competition: athletes
  • Commercial: spear fishers, pearl divers
  • Recreational
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8
Q

Describe Boyle’s Law

A
  • Pressure of given mass of ideal gas is inversely proportional to its volume at constant temperature
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9
Q

How does Boyle’s Law relate to diving?

A
  • Deeper dive = increased pressure = decreased volume
  • every 10m of depth increased in pressure by 1atm, volume decrease by 1/2
  • on the way up, it is reverse
  • Density of gas remains the same
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10
Q

What is Shallow Water Blackout?

A
  • Passing out in water and drowning
  • Results due to low O2
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11
Q

How does Shallow Water Blackout Occur?

A

O2 decreases below the threshold for consciousness before CO2 increases above the threshold for the urge to breathe
- Hyperventilation before diving: Reduces CO2 in blood
- Diving deep: increases pressure, increases O2 in blood
- On the way up Pressure decreases, O2 decreases and you pass out

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12
Q

How do you avoid blackout?

A
  • Never Swim Alone
  • Never ignore urge to breathe
  • Certified lifeguard on duty
  • Do not attempt long or competitive kicks for any reason
  • Only perform underwater training activities with proper supervision
  • Never compete with other swimmers to see who can swim the farthest underwater
  • Never play breath holding games
  • Never hyperventilate before performing underwater swim or kick
  • Proper buffer time between training
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13
Q

What is the common term ‘squeezes’ referring to?

A
  • Hyperbaric Trauma
  • Pressure Injury
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14
Q

Describe a Mask Squeeze

A
  • pressure difference between Scooba Mask and ambient pressure
  • Blood squeezes outside of blood vessels in the eye, white part
  • Does not affect vision or long-term vison
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15
Q

Describe Ear Squeeze

A
  • Pressure difference between the middle and outer ear
  • Outside tympanic membrane: ambient pressure
  • Inside tympanic membrane: different pressure
  • Eustachian tube: allows for pressure equalization
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16
Q

What are the risk factors of Ear Squeeze?

A
  • Upper respiratory infection
  • Difficulty clearing ears
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17
Q

What is the main symptom of Ear Squeeze?

A
  • Pain
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18
Q

Describe a Sinus Squeeze

A
  • Poor communication to nose
  • Congestion, edema, bleeding
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19
Q

When does a Sinus Squeeze occur?

A
  • Infection; edema; or swelling
  • Interference in communication with sinus and nasal pharynx
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20
Q

Describe Skin Squeeze

A
  • Dry suit seals to wrist, neck and ankles
  • Volume decreases with depth
  • Suit presses against the skin
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21
Q

When is a dry suit used while diving?

A
  • in Cold Water
  • To keep you dry
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22
Q

How can Skin Squeeze be reduced?

A
  • Better technique
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23
Q

What is pulmonary Barotrauma?

A
  • Pressure injury in the lung
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24
Q

What are the two types of Pulmonary Barotrauma?

A
  • Pneumothorax
  • Arterial Gas Embolism
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25
Q

What happens when you go up to fast in the water when diving?

A
  • Air expands and can burst lung
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26
Q

Where can air expand and damage the lung when rising to fast when diving?

A

Alveolus
- Into Capillary: Arterial Gas Embolism
- Into Mediastinum or Pleural Cavity: Pneumothorax

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27
Q

What is a Pneumothorax?

A
  • Collapsed Lung
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28
Q

What is an Arterial Gas Embolism?

A
  • Air Bubbles in the blood
29
Q

What is a Pulmonary Embolism?

A
  • Clot that gets lodged
30
Q

What can happen with Gas trapping? What can it lead to?

A

Pulmonary Barotrauma
- No gas exchange: hypoxic

31
Q

Describe the facts of Arterial Gas Embolism

A
  • Sometimes called Air Embolism
  • Kills 5% of divers immediately
  • 50% will completely recover
  • Symptoms depend on tissue affected
  • Extremely Variable
32
Q

How does Arterial Gas Embolism occur?

A
  • Bubbles of air leave alveoli
  • Enters Arterial Side
  • Travels throughout body causing blockages to blood flow
33
Q

How do 5% of divers die immediately when they get an Arterial Gas Embolism?

A
  • Cardiac Arrest
34
Q

What are the different types of symptoms for Arterial Gas Embolism?

A
  • Cerebral: Numbness; weakness; altered consciousness; poor cognition
  • Cardiac: Cardiac Arrest; Myocardial Infraction
  • Other Organs: Aspiration; Altered Laboratory Enzymes
35
Q

What are the prehospital treatments of an arterial gas embolism?

A
  • emergency evacuation
  • Oxygen: increase temporary oxygen can lessen hypoxia
  • Positioning Trendelenburg: Position head down, bubbles against gravity
  • Treat near-drowning if necessary
  • Fluids (IV if possible): improve blood flow
36
Q

What is the treatment for an Arterial Gas Embolism at the hospital?

A
  • Use Recompression Chamber
  • Increase pressure to allow bubbles to decrease in volume
37
Q

What are the parameters for the recompression chamber?

A
  • Typically 2.8-6atm of pressure
  • 100% O2
  • Resolubilizes the bubbles
  • Variety of different protocols
38
Q

What are the causes of decompression sickness?

A
  • Formation of bubbles of inert gases in the bloodstream
  • Occurs upon ascent/depressurization
39
Q

How does Decompression Sickness happen?

A

When diving
- Nitrogen dissolves in blood at high pressure (deep depths)
When Returning to the Surface
- Very small bubbles that come out of solution
- Get lodged in small vessels in the bloodstream

40
Q

What is similar between Pulmonary Barotrauma and Decompression Sickness? What is different?

A

Both
- Bubbles end up in the bloodstream
- Dangerous
Pulmonary Barotrauma
- Bubbles come from lungs
Decompression Sickness
- Bubbles dissolve out of solution (bloodstream)

41
Q

What is Henry’s Law?

A
  • The amount of gas that will dissolve in the liquid relates directly to the pressure of the gas
42
Q

What are the symptoms and signs of Musculoskeletal Decompression Sickness?

A

Symptoms
- Joint Pain
- Tingling
- Numbness
- Swelling
Signs
- Tenderness
- Pain with joint motion

43
Q

What are the symptoms and signs of Neurological Decompression Sickness?

A

Symptoms
- Back Pain
- Abdominal Pain
- Weakness or Paralysis
- Urine Retention
- Incontinence
Signs
- Decreased Sensation
- Weakness

44
Q

What are the symptoms and signs of Brain Decompression Sickness?

A

Symptoms
- Visual Loss
- Headache
- Confusion
Signs
- Disorientation
- Abnormal Visual Field Testing

45
Q

What are the symptoms and signs of Cutaneous Decompression Sickness?

A

Symptoms
- Pruritis (itchiness)
Signs
- Mottled Skin

46
Q

What are the symptoms and signs of the Chokes?

A

Symptoms
- Dyspnoea
- Cough
- Chest Pain
Signs
- Cyanosis
- Tachycardia
- Tachypnoea

47
Q

What are the symptoms and signs of Decompression Shock?

A

Symptoms
- Weakness
- Sweating
- Unconsciousness
Signs
- Hypotension
- Tachycardia
- Pallor
- Decreased Urination

48
Q

What is the prehospital treatment for Decompression Sickness?

A
  • Emergent Evacuation
  • Give Oxygen
  • Treat near-drowning if necessary
  • Fluids (IV if possible)
49
Q

What is the Hospital Treatment for Decompression Sickness?

A
  • Use Recompression Chamber
50
Q

What are the outcomes of Decompression Sickness Treatment?

A

Most patients do well
- 75% of patients become completely asymptomatic
- 16% will have residual symptoms at 3 months

51
Q

What’s the best way to avoid Decompression Sickness?

A
  • Dive Tables: estimate nitrogen build-up
  • Dive Computers: Track Diving Data (shows nitrogen build-up)
52
Q

What are the greatest risk factors of decompression sickness?

A
  • Exceeding depth-time exposure limits
  • Rapid Ascent
  • Dehydration
  • Residual Deficits from previous decompression Sickness
  • Obesity
  • Lung Disease
  • Intracardiac Septal Defects
53
Q

Is it safe to fly after diving?

A
  • Not for 12 hours
54
Q

Why might Asthma be a problem for scuba divers?

A
  • Asthma causes airway obstruction
  • Gas Trapping, can lead to pulmonary barotrauma
55
Q

What are the current Guidelines for Asthmatics and Diving from the British Thoracic Society?

A

Do not dive if:
- Wheeze precipitated by cold, exercise, or emotion
Dive if (without medication):
- Free of Asthma Symptoms
- Normal lung Function Tests
- Normal Exercise Tests

56
Q

What should asthmatics who wish to dive do?

A

Monitor Asthma with:
- Twice Daily peak flow tests
- Refrain from diving if symptomatic
- Refrain from diving if Peak Flow rates < 90% normal

57
Q

What is common about all the epidemiological evidence for the risk of asthma during diving?

A
  • low quality
  • potential for bias
58
Q

What is Immersion Platypnea?

A
  • Combination of upright status, immersion and exertion
  • Platypnea = shortness of breath, relieved when lying down
59
Q

What is Immersion Pulmonary Edema thought to be caused by?

A
  • Exercise and immersion-induced increase in pulmonary artery pressure
  • overpressure and leakage
60
Q

What is thought to exacerbate Immersion Pulmonary Edema? why?

A
  • Cold water
  • Immersion
  • Exercise
    Why?
  • Raise in Pulmonary Artery Pressure
61
Q

What are the Symptoms of Immersion Pulmonary Edema?

A
  • Cough
  • Dyspnea
  • Haemoptysis
  • Hypoxemia
  • Loss of Consciousness
  • Death
62
Q

Why does immersion impact pulmonary edema?

A
  • Blood pools in core
  • Increases pulmonary artery pressure
63
Q

What are the Risk factors of Immersion Pulmonary Edema?

A
  • Heavy Exertion
  • Cold Water
  • Immersion
64
Q

Who gets Immersion Pulmonary Edema?

A
  • Healthy Divers
  • Swimmers
  • Some Special Forces
65
Q

What conditions can lead to immersion pulmonary edema?

A
  • Short to prolonged exposure
  • Cold to thermoneutral temperature
66
Q

What are some Facts about Immersion Pulmonary Edema?

A
  • 197 cases now reported in literature
  • SCUBA divers, breathhold divers, military swimmers and triathletes
  • Surface to 72m depth, all temperature ranges (2-25Degrees)
67
Q

What is the treatment for immersion pulmonary edema?

A
  • Nifedipine reduces La threshold and peak power in athletes
  • Dexamethasone - prohibited substance
  • Salmeterol (LABA): potential for alveolar fluid clearance
  • Sildenafil (Viagra): shown reduce in PAP in IPE susceptibles
  • All proposed treatments
68
Q

What’s the difference between Decompression Illness and Decompression Sickness?

A

Decompression Illness
- Overarching term that covers both decompression sickness and arterial gas embolism

69
Q

How can you prevent Decompression Illness and other conditions?

A
  • Follow dive tables
  • Avoid Rapid Ascents
  • Decompression stops on all dives: go up slowly, take stops
  • Never hold breath will diving: like an expanding balloon
  • No Flying after Diving

KIN 424 - Medical Aspects of Sport (11 decks)

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