Treatment tables chapter 17 Flashcards
What are the different manning levels for recompression treatment?
Minimum (3 Personnel): SUP, IT, OT
Ideal (7 Personnel): DO, MDV, SUP, DMO, IT, OT, LOGS
Emergency (2 Personnel): SUP, IT
Who is responsible to the Commanding Officer for the safe conduct of recompression chamber operations and for presenting recommended changes to treatment protocols to the Commanding Officer?
Diving Officer
Who is the most qualified person to supervise recompression treatments?
Master Diver
What are the Diving Supervisor’s responsibilities (dive team)?
Execution of treatment protocols, emergency procedures, and supervision of the chamber team.
Communicating with personnel inside the chamber.
Adhering to the rules for recompression treatment.
DMO is contacted at the earliest opportunity during treatment and before release of any patient from the treatment facility.
Ensuring treatment progress is thoroughly documented in the recompression chamber log and the command dive bill.
Tracking bottom time and the decompression profiles of personnel locking in and out of the chamber
Ensuring the decompression profiles of persons locking in and out of the chamber are logged in the chamber log.
What makes a medical officer a DMO?
Graduate of the Diving Medical Officer course taught at the NDSTC
Subspecialty code of 16U0 (Basic Undersea
Medical Officer) or 16U1 (Residency in Undersea Medicine trained Undersea Medical Officer).
What treatment tables must you consult with a DMO prior to committing a patient to?
Treatment Tables 4,7
Are Medical Officers who complete only the nine-week diving medicine course at NDSTC considered to have the same privileges as DMOs?
Yes, with the exception they are not granted the privilege of modifying treatment protocols.
Can Non-diving medical personnel qualify as an Inside Tender via the Military Diver Inside Tender PQS?
Yes; must have a diving physical exam, conform to Navy physical standards, and pass the diver candidate pressure test.
What are Inside Tenders responsible for?
Be familiar with all treatment procedures and the signs, symptoms, and treatment of all diving-related disorders.
Releasing the door latches (dogs) after a seal is made.
Communicating with outside personnel.
Providing first aid
Monitoring vital signs.
Administering treatment gas
Monitoring for signs of CNS oxygen toxicity.
Ensuring that sound attenuators for ear protection
Ensuring that the patient is lying down and positioned to permit free blood circulation to all extremities.
What is a higher priority than recompression for a patient with no pulse or respirations?
Access to ACLS
What may be administered at depth for a diver with no pulse or respirations?
CPR, Patient Monitoring, and Drug Administration (ACLS).
What actions should be taken if the pulseless diver regains vital signs after administering an AED or ACLS?
Continue, or begin, transport to the nearest critical care facility prior to recompression.
When should a pulseless diver be recompressed?
When there is no possibility of evacuation.
What actions should be taken if n AED is not available and evacuation is not an option for a patient with no pulse or reparations?
Recompress the patient to 60 feet, continue BLS measures, and contact a UMO. If an AED becomes available, surface the chamber at 30fpm and apply the AED.
If the diver regains pulse, continue with recompression and monitor the patient closely.
Unless defibrillation is administered within how many minutes, the diver likely will die, even if adequate CPR is performed, with or without recompression?
10 minutes
What are the three types of type 1 decompression sickness?
Joint pain (musculoskeletal or pain-only symptoms)
skin (cutaneous symptoms)
Swelling and pain in lymph nodes
What are the most common sites of joint pain?
Shoulder, elbow, wrist, hand, knee, and ankle
What are the hallmark symptoms of Type I joint pain?
Dull, aching quality and confinement to particular areas.
It is always present at rest and is usually unaffected by movement.
Any pain occurring from the abdominal thoracic area, including the hips should be considered as symptoms arising from spinal cord involvement and treated as what?
Type 2 decompression sickness
What symptoms may indicate spinal cord involvement?
Pain localized to joints between the ribs and spinal column or joints between the ribs and sternum.
A shooting-type pain that radiates from the back around the body (radicular or girdle pain).
A vague, aching pain in the chest or abdomen (visceral pain).
Why should pain not be treated with drugs in an effort to make the patient more comfortable?
The pain may be the only way to localize the problem and monitor the progress of treatment.
The most common skin manifestation of decompression sickness is what?
Itching ( transient and does not require recompression)
Faint skin rashes may accompany the itching (also does not require recompression)
Describe cutis mormorata?
Mottling or marbling of the skin
Starts as intense itching
Progresses to redness
Then gives way to a patchy, dark-bluish discoloration of the skin
What may still be present at the end of the treatment of lymphatic type 1 DCS?
Recompression may provide prompt relief from pain. The swelling may still be present at the completion of treatment.
What actions should be taken if symptoms of musculoskeletal pain have shown absolutely no change after the second oxygen breathing period at 60 feet and it is determined that the patient’s pain is most likely an orthopedic injury rather than decompression sickness?
Consult a DMO. If the DMO feels that the pain can be related to specific orthopedic trauma or injury, a Treatment Table 5 may be completed.
If a DMO is not consulted, Treatment Table 6 shall be used.
What are the symptoms of Type II decompression sickness?
Neurological Symptoms
Inner Ear Symptoms (Staggers)
Cardiopulmonary Symptoms (Chokes)
What are the common symptoms of neurological Type II DCS?
Numbness
Paresthesias (a tingling, pricking, creeping,
“pins and needles,” or “electric sensation on the skin)
Decreased sensation to touch
Muscle weakness
Paralysis
Mental status changes
Motor performance alterations
In neurological DCS, lower spinal cord involvement can cause disruption of what?
Urinary function
When does inner ear decompression sickness occur most often?
In helium-oxygen diving and during decompression when the diver switched from breathing helium-oxygen to air.
Typically, what is not present in cerebellar decompression sickness but present in IEB?
Rapid involuntary eye movement (nystagmus)
What causes cardiopulmonary chokes?
If profuse intravascular bubbling occurs, symptoms of chokes may develop due to congestion of the lung circulation.
What are the symptoms of cardiopulmonary chokes?
Start as chest pain aggravated by inspiration and/or as an irritating cough.
Increased breathing rate is usually observed.
Symptoms of increasing lung congestion may progress to complete circulatory collapse, loss of consciousness, and death if recompression is not instituted immediately.
When should a patient be compressed to depth of relief (or significant improvement), not to exceed to 165 fsw?
If severe symptoms (e.g. paralysis, major weakness, memory loss) are unchanged or worsen within the first 20 minutes at 60 fsw.
To limit recurrence, severe Type II symptoms warrant what?
Full extensions at 60 fsw even if symptoms resolve during the first oxygen breathing period.
What treatment table is not an appropriate treatment for symptomatic uncontrolled ascent?
TT5; Conduct a rapid assessment and compress the patient to 60 fsw.
What is the treatment for a diver that makes an uncontrolled ascent from 50 feet or shallower?
TT6
What is the treatment for a diver that makes an uncontrolled ascent from deeper than 50 feet?
TT6A (compress to 60 fsw or the depth where the symptoms are significantly improved, not to exceed 165 fsw)
What is the treatment for a diver that makes an uncontrolled ascent from deeper than 165 feet.
TT8, recompress to depth of relief not to exceed 225 feet.
DCS involving the spinal cord or brain is more common in altitude DCS?
Brain (spinal cord DCS is more common in diving)
How is altitude decompression sickness treated if only joint pain was present but resolved before reaching one ata from altitude?
Two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation
How is altitude DCS treated for symptoms other than pain, or if joint pain symptoms are present after return to one ata?
The stricken individual should be transferred to a recompression facility and treated on the appropriate treatment table, even if the symptoms resolve while in transport.
Individuals should be kept on 100 percent oxygen during transfer to the recompression facility.
What are the primary objectives of recompression treatment?
Compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow.
Allow sufficient time for bubble resorption
Increase blood oxygen content and thus oxygen delivery to injured tissues
(R>R>R)
What are the guidelines on recompression treatments?
Treat promptly and adequately.
The effectiveness of treatment decreases as the length of time between the onset of symptoms and the treatment increases.
Do not ignore seemingly minor symptoms.
They can quickly become major symptoms.
Follow the selected treatment table unless changes are recommended by a
Diving Medical Officer.
If multiple symptoms occur, treat for the most serious condition.
When should air treatment tables be used?
Oxygen system failure or
Intolerable patient oxygen toxicity problems with DMO recommendation.
When should a treatment table 1A, 2A and 3 be used?
1A: pain is relieved at a depth less than 66 feet
2A: pain is relieved at a depth greater than 66 feet
3: used for treatment of serious symptoms if symptoms are relieved within 30 minutes at 165 feet.
How should a patient be transported to a recompression chamber?
Patient should be kept supine (lying horizontally)
Kept warm
Monitored continuously for signs of obstructed (blocked) airway, cessation of breathing, cardiac arrest, or shock.
If symptoms of decompression sickness or arterial gas embolism are relieved or improve after breathing 100 percent oxygen while in transit to a recompression chamber, how should the patient be treated?
Patient should still be recompressed as if the original symptom(s) were still present.
How long are patients observed after a treatment for reoccurrence of symptoms?
2 hours for pain-only symptoms
6 hours for serious symptoms.
Do not release patient without consulting a DMO.
Never interrupt chest compressions for longer than what period of time?
10 seconds
In an emergency, when may an uncertified chamber be used?
A qualified Chamber Supervisor deems it safe to operate.
If a diver is suffering from AGE or severe type 2 DCS symptoms, and a there is no prospect of reaching a recompression chamber within a reasonable time frame, what are you actions?
Have diver breath 100% oxygen on the surface for 30 minutes. If symptoms do not stabilize or improve within 30 minutes start in-water decompression.
When should in water decompression be used?
As a last resort. When a recompression facility is not within a reasonable time frame (12-24 hours).
For in-water recompression using air, what treatment table should be followed as closely as possible?
Treatment Table 1A
What actions should be taken if the depth is too shallow for full treatment according to Air Treatment Table 1A?
Recompress the patient to the maximum available depth.
Remain at maximum depth for 30 minutes.
Decompress according to Air Treatment Table 1A
What is the protocol if a diver is recompressed in the water using an oxygen rebreather, an ORCA, or other device?
Put the stricken diver on the UBA and have the diver purge the apparatus at least three times with oxygen.
Descend to a depth of 30 feet with a standby diver.
Remain at 30 feet, at rest, for 60 minutes for Type I symptoms and 90 minutes for Type II symptoms.
Ascend to 20 feet even if symptoms are still present.
Decompress to the surface by taking 60-minute stops at 20 feet and 10 feet.
After surfacing, continue breathing 100 percent oxygen for an additional 3 hours.
What can a treatment table 5 be used to treat?
Type I DCS
Asymptomatic omitted decompression
Treatment of resolved symptoms following in-water recompression
Follow-up treatments for residual symptoms
Carbon monoxide poisoning
Gas gangrene