Treatment tables chapter 17 Flashcards
1
Q
What are the different manning levels for recompression treatment?
A
Minimum (3 Personnel): SUP, IT, OT
Ideal (7 Personnel): DO, MDV, SUP, DMO, IT, OT, LOGS
Emergency (2 Personnel): SUP, IT
2
Q
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?
A
Diving Officer
3
Q
Who is the most qualified person to supervise recompression treatments?
A
Master Diver
4
Q
What are the Diving Supervisor’s responsibilities (dive team)?
A
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.
5
Q
What makes a medical officer a DMO?
A
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).
6
Q
What treatment tables must you consult with a DMO prior to committing a patient to?
A
Treatment Tables 4,7
7
Q
Are Medical Officers who complete only the nine-week diving medicine course at NDSTC considered to have the same privileges as DMOs?
A
Yes, with the exception they are not granted the privilege of modifying treatment protocols.
8
Q
Can Non-diving medical personnel qualify as an Inside Tender via the Military Diver Inside Tender PQS?
A
Yes; must have a diving physical exam, conform to Navy physical standards, and pass the diver candidate pressure test.
9
Q
What are Inside Tenders responsible for?
A
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.
10
Q
What is a higher priority than recompression for a patient with no pulse or respirations?
A
Access to ACLS
11
Q
What may be administered at depth for a diver with no pulse or respirations?
A
CPR, Patient Monitoring, and Drug Administration (ACLS).
12
Q
What actions should be taken if the pulseless diver regains vital signs after administering an AED or ACLS?
A
Continue, or begin, transport to the nearest critical care facility prior to recompression.
13
Q
When should a pulseless diver be recompressed?
A
When there is no possibility of evacuation.
14
Q
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?
A
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.
15
Q
Unless defibrillation is administered within how many minutes, the diver likely will die, even if adequate CPR is performed, with or without recompression?
A
10 minutes
16
Q
What are the three types of type 1 decompression sickness?
A
Joint pain (musculoskeletal or pain-only symptoms)
skin (cutaneous symptoms)
Swelling and pain in lymph nodes
17
Q
What are the most common sites of joint pain?
A
Shoulder, elbow, wrist, hand, knee, and ankle
18
Q
What are the hallmark symptoms of Type I joint pain?
A
Dull, aching quality and confinement to particular areas.
It is always present at rest and is usually unaffected by movement.
19
Q
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?
A
Type 2 decompression sickness
20
Q
What symptoms may indicate spinal cord involvement?
A
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).
21
Q
Why should pain not be treated with drugs in an effort to make the patient more comfortable?
A
The pain may be the only way to localize the problem and monitor the progress of treatment.
22
Q
The most common skin manifestation of decompression sickness is what?
A
Itching ( transient and does not require recompression)
Faint skin rashes may accompany the itching (also does not require recompression)
23
Q
Describe cutis mormorata?
A
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
24
Q
What may still be present at the end of the treatment of lymphatic type 1 DCS?
A
Recompression may provide prompt relief from pain. The swelling may still be present at the completion of treatment.
25
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.
26
What are the symptoms of Type II decompression sickness?
Neurological Symptoms
Inner Ear Symptoms (Staggers)
Cardiopulmonary Symptoms (Chokes)
27
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
28
In neurological DCS, lower spinal cord involvement can cause disruption of what?
Urinary function
29
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.
30
Typically, what is not present in cerebellar decompression sickness but present in IEB?
Rapid involuntary eye movement (nystagmus)
31
What causes cardiopulmonary chokes?
If profuse intravascular bubbling occurs, symptoms of chokes may develop due to congestion of the lung circulation.
32
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.
33
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.
34
To limit recurrence, severe Type II symptoms warrant what?
Full extensions at 60 fsw even if symptoms resolve during the first oxygen breathing period.
35
What treatment table is not an appropriate treatment for symptomatic uncontrolled ascent?
TT5; Conduct a rapid assessment and compress the patient to 60 fsw.
36
What is the treatment for a diver that makes an uncontrolled ascent from 50 feet or shallower?
TT6
37
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)
38
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.
39
DCS involving the spinal cord or brain is more common in altitude DCS?
Brain (spinal cord DCS is more common in diving)
40
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
41
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.
42
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)
43
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.
44
When should air treatment tables be used?
Oxygen system failure or
| Intolerable patient oxygen toxicity problems with DMO recommendation.
45
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.
46
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.
47
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.
48
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.
49
Never interrupt chest compressions for longer than what period of time?
10 seconds
50
In an emergency, when may an uncertified chamber be used?
A qualified Chamber Supervisor deems it safe to operate.
51
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.
52
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).
53
For in-water recompression using air, what treatment table should be followed as closely as possible?
Treatment Table 1A
54
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
55
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.
56
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
57
What can a treatment table 6 be used to treat?
Arterial gas embolism
Type II DCS symptoms
Type I DCS symptoms: where relief is not complete within 10 minutes at 60 feet or where pain is severe and immediate recompression must be instituted before a neurological examination can be performed
Cutis marmorata
Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation
Asymptomatic omitted decompression
Symptomatic uncontrolled ascent
Recurrence of symptoms shallower than 60 fsw
58
When is a treatment table 6A used?
Treat AGE or DCS symptoms when severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw.
Compressed to depth of relief (or significant improvement), not to exceed 165 fsw.
Time at depth shall be 30 minutes
59
When would a treatment table 4 be used?
Patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw.
Time at depth shall be between 30 to 120 minutes
DMO should be consulted before a shift to a TT4 is made.
60
What are the lengths of oxygen breathing periods on a treatment table 4 and 7?
25 / 5
61
Immediately upon arrival at 60 feet on a TT4, what minimum number of oxygen breathing periods should be administered?
4 oxygen breathing periods (for a total of 2 hours)
After that, oxygen breathing should be administered to suit the patient’s individual needs and operational conditions.
62
On a TT4, both the patient and tender must breathe oxygen for at least how many hours beginning no later than 2 hours before ascent from 30 feet is begun?
4 Hours (eight 25-minute oxygen, 5-minute air periods)
These oxygen-breathing periods may be divided up as convenient, but at least 2 hours’ worth of oxygen breathing periods should be completed at 30 feet.
63
What is a treatment table 7 and extension of?
Extension at 60 feet of Treatment Table 6, 6A, or 4 (or any other nonstandard treatment table).
64
What is a treatment table 7 used for?
Heroic measure for treating non-responding severe gas embolism or life-threatening decompression sickness
Should be used only when loss of life may result if the currently prescribed decompression from 60 feet is undertaken
65
Committing to a TT7 requires ministering to a patients needs in the recompression chamber for what period of time?
48 hours or longer
66
What is the minimum time spent at 60 feet on a TT7?
12 hours
67
What action is most likely to be taken if a patient has not shown improvement during the first 12 hours at 60 feet on a TT7?
Benefit from additional time at 60 feet is unlikely and decompression should be started.
68
While the actual time that can be spent at 60 feet is unlimited, time beyond 12 hours can only be determined by whom?
DMO
69
When would additional time at 60 feet be warranted on a TT7?
Patient is improving but significant residual symptoms remain (e.g., limb paralysis, abnormal or absent respiration)
70
On a TT7, Solid evidence of continued benefit should be established for stays longer than how many hours at 60 feet?
18 Hours
71
Do inside tenders breathe oxygen at any point during a TT7?
No; tenders breathe chamber atmosphere throughout treatment and decompression.
72
What precautions are taken to prevent inadvertent early surfacing on a TT7?
Upon arrival at 4 feet, decompression should be stopped for 4 hours
At the end of 4 hours, decompress to the surface at 1 foot per minute.
73
What is the decompression for a TT7?
58 – 40 feet: 3ft/hr (40 min)
40 – 20 feet: 2ft/hr (60 min)
20 – 4 feet: 1ft/hr (120 min)
Upon arrival to 4 feet stop decompression.
Stay at depth for 4 hours.
After 4 hours decompress to the surface at I foot per minute.
74
On a TT7, four oxygen breathing periods are alternated with how many hours of continuous air breathing?
2 hours
75
How many oxygen breathing periods are required at 60 fsw on a TT7 for a conscious patient?
8 oxygen breathing periods (previous 100 percent oxygen breathing periods may be counted against these eight periods).
Beyond that, oxygen breathing periods should be continued as recommended by the Diving Medical Officer
76
What actions should be taken if oxygen breathing causes significant pain on inspiration during the course of a TT7?
It should be discontinued unless it is felt that significant benefit from oxygen breathing is being obtained.
77
In unconscious patients, oxygen breathing should be stopped after a maximum of how many oxygen breathing periods have been administered?
24
78
When may a patient sleep in the chamber?
At any time except when breathing oxygen deeper than 30 feet.
While asleep, the patient’s pulse, respiration, and blood pressure should be monitored and recorded
79
What is a treatment table 8 used for treating?
Deep uncontrolled ascents when more than 60 minutes of decompression have been missed.
80
What is treatment depth limitation for a patient being treated on a TT8?
Compress symptomatic patient to depth of relief not to exceed 225 fsw.
81
What is a TT9 used for?
Residual symptoms remaining after initial treatment of AGE/DCS
Selected cases of carbon monoxide or cyanide poisoning
Smoke inhalation.
82
What is the treatment depth of a TT9?
45 fsw (90 minutes of oxygen breathing)
83
What are permissible ranges for the chamber atmosphere?
Oxygen: 19-25%
CO2: 1.5 SEV
84
When should CO2 absorbent be replaced in the chamber?
Partial pressure of carbon dioxide in the chamber reaches 1.5 percent SEV
CO2 absorbent has expired
85
What shall pre-packed, double bagged canisters be labeled with?
Expiration date from the absorbent bucket
86
What are the time/temperatures exposure times in the chamber?
Under 85 F (unlimited): All Treatments
85 – 94 F (6 hours): TT 5, 6, 6A, 1A, 9
95 – 104 F ( 2 hours): TT 5, 9
Over 104 F ( intolerable) : No treatments
87
What are the different thermometers than can be used in a recompression chamber?
electronic, bimetallic, alcohol, or liquid crystal thermometers
88
What is considered sufficient hydration over the course of a TT5 or 6?
1 to 2 liters of water, juice, or non-carbonated drink
89
What patients should be considered / always given IV fluids?
Considered: AGE /Type II DCS
Always: Stuporous or unconscious
90
What is the required drip rate of an IV?
75 to 100 cc/hour
91
What type of IV fluids should be used for patients?
Isotonic fluids (Lactated Ringer’s Solution, Normal Saline)
92
When should you avoid using IV fluids that contain glucose (Dextrose)?
If brain or spinal cord injury is present.
| Intravenously administered glucose may worsen the outcome
93
What actions should be taken if a patient is unable to urinate due to the bladder being possibly paralyzed?
A urinary catheter shall be inserted as soon as possible by trained personnel
Inflate catheter balloons with liquid, not air
94
When is it considered that adequate fluid is being given to a patient?
When urine output is at least 0.5cc/kg/hr.
Useful indicator of proper hydration is a clear colorless urine.
95
What is mandatory when doing a Treatment Table 4, 7, or 8?
Double-lock chamber
96
All chamber occupants may breathe 100 percent oxygen at what depths without locking in additional personnel?
45 feet or shallower
97
Normally, tenders should allow a surface interval of at least how many hours between consecutive treatments on Treatment Tables 1A, 2A, 3, 5, 6, 6A, and Tables 4, 7, and 8?
18 Hours (1A, 2A, 3, 5, 6, 6A)
48 Hours (4,7,8)
98
Surface intervals for what treatment table must be strictly adhered to?
Treatment Tables 1A, 2A, 3, 4, 7, and 8
99
Select a treatment gas that will produce a ppO2 between what at treatment depths?
1.5 and 3.0 ata
100
Regardless of the level of activity, CNS oxygen toxicity is unlikely/very unlikely in resting individuals at chamber depths?
Unlikely: 50 feet and shallower
Very Unlikely: 30 feet and shallower
101
Patients with severe Type II decompression sickness or arterial gas embolism symptoms may be abnormally sensitive to what?
CNS oxygen toxicity
102
What actions are taken at the first sign of CNS oxygen toxicity for TT 5, 6, 6A / 4, 7 or 8?
Patient should be removed from breathing oxygen
Wait 15 minutes after all symptoms have subsided; continue oxygen breathing
5/6/6A: resume treatment at the point of interruption
4/7/8: no compensatory lengthening of the table is required
103
What actions should be taken if symptoms of CNS oxygen toxicity develop again or if the first symptom is a convulsion?
Patient should be removed from breathing oxygen
After all symptoms have completely subsided, decompress 10 feet at a rate of 1 fsw/min.
For a convulsion, begin travel when the patient is fully relaxed and breathing normally.
5/6/6A: resume oxygen breathing at the point of interruption (if another symptom occurs contact DMO for appropriate modification)
4/7/8: consult with a DMO before administering further oxygen breathing; no lengthening required.
104
If oxygen breathing must be continued beyond the period of substernal burning, or if the 2-hour air breaks on Treatment Tables 4, 7, or 8 cannot be used because of deterioration upon the discontinuance of oxygen, the oxygen breathing periods should be changed to what?
20 minutes on oxygen, followed by 10 minutes breathing chamber air or alternative treatment gas mixtures with a lower percentage of oxygen should be considered.
105
What actions should be taken when a loss of oxygen occurs during the course of a treatment (5/6/6A)?
Repaired within 15 minutes: resume treatment at point of interruption
Repaired after 15 minutes but before 2 hours: complete treatment with maximum number of O2 extensions.
106
What actions should be taken of there is a loss of oxygen during the course of a TT 4/7 or 8?
No compensation in decompression is needed
If decompression must be stopped because of worsening symptoms, then stop decompression. When oxygen is restored, continue treatment from where it was stopped.
107
What actions are taken if O2 breathing cannot be restored in 2 hours?
Switch to the comparable air treatment table at current depth for decompression if 60 fsw or shallower
108
If being treated on an air table and symptoms worsen and an increase in treatment depth deeper than 60 feet is needed, what Treatment Table is mandatory?
TT4
109
Tenders that rode a TT 5, 6, 6A, 1A, 2A, or 3 has a required surface of what?
18 hours for no decompression dive
24 hours for a decompression dive
110
Tenders that rode a TT 4, 7, 8 have a required surface interval of what prior to diving?
48 hour surface interval
111
Patients should remain around the recompression chamber for how long after riding a TT5?
2 hours
112
Patients should remain around the recompression chamber for how long after be treated for type 2 symptoms or rod a TT6 for type 1 symptoms?
6 hours
113
How close do all patients have to stay to a recompression chamber after treatment?
Within 60 minutes for 24 hours (30 minutes if shortens observation period)
Tenders are also required if they were on a TT 4, 7, or 8
114
For divers that have been treated for AGE/DCS and have had complete relief should not fly for how long?
72 hours
115
What is the required surface interval prior to flying for tenders on a TT 5, 6, 6A, 1A, 2A, or 3? 4, 7 8?
24 hours (TT 5, 6, 6A, 1A, 2A, 3)
72 hours (4,7,8)
116
How long after being diagnosed and treated for AGE / Type 2 DCS can you return to diving duty?
30 days
117
Patients that require an air evacuation to another treatment or medical facility should be transported using what type of aircraft if possible?
Aircraft pressurized to one ata should be used if possible, or unpressurized aircraft flown as low as safely possible (no more than 1,000 feet is preferable).
118
What is the treatment of persistent Type II residual symptoms?
Daily treatment on Table 6 or twice-daily treatments on Treatment Tables 5 or 9.
119
For patients with severe pulmonary oxygen toxicity, what protocol should be used when breathing oxygen at 45 or 60 feet is uncomfortable when treating for residual symptoms?
Daily treatments at 30 feet
As many oxygen breathing periods (25 minutes on oxygen followed by 5 minutes on air) should be administered as can be tolerated by the patient.
Ascent to the surface is at 20 feet per minute.
A minimum oxygen breathing time is 90 minutes.
A practical maximum bottom time is 3 to 4 hours at 30 feet.
120
In general, follow-up treatments may be discontinued if there is no further sustained improvement on how many consecutive treatments?
2
121
Treatments should not be administered on a daily basis for more than 5 days without a break of at least how many days?
1 day
122
Divers diagnosed with Type I DCS may be medically cleared to return to diving duty how many days after successful completion of hyperbaric treatment by a DMO?
7 Days
123
What kind of waiver is required to return to diving if symptoms persist beyond initial treatment of AGE or Type II DCS?
A BUMED waiver for return to diving
124
What is the protocol if death occurs following initial recompression to 60, 165, or 225 on Treatment Tables 6, 6A, 4 or 8?
Decompress the tenders on the Air/Oxygen schedule having a depth exactly equal to or deeper than the maximum depth attained during the treatment and a bottom time equal to or longer than the total elapsed time since treatment began.
125
If death occurs after leaving the initial treatment depth on Treatment Tables 6 or 6A,
Decompress the tenders at 30 fsw/min to 30 fsw
Have them breathe oxygen at 30 fsw for the times indicated in a TT6
Following completion of the oxygen breathing time at 30 fsw, decompress the tenders on oxygen from 30 fsw to the surface at 1 fsw/min.
126
If death occurs after leaving the initial treatment depth on Treatment Tables 4 or 8 or after beginning treatment on Treatment Table 7 at 60 fsw,
Follow the original treatment table to 60 fsw.
Tenders breathe oxygen for 90 min in three 30-min periods
Continue decompression at 50, 40 and 30 fsw by breathing oxygen for 60 min at each depth (50 = 2 x :30, 40/30 = 1 x :60)
At 20 fsw breathe oxygen for 120 Divide the oxygen time at 20 fsw into two 60-min periods separated by a 15 min air break.
All ascent rates are 30 fsw
127
What is the protocol for impeding natural disaster?
If deeper than 60fsw, go to 60fsw
Put all occupant on 100% oxygen
Select table equal to depth and bottom time
Breathe oxygen for the sum of all decompression requirement 60fsw and deeper
When time is out, try and not to ascend any faster than 10 fsw/min
128
What can be used to achieve high inspired fractions of oxygen to a patient during transport?
High-flow (15 liters/minute) oxygen source with a reservoir mask or a demand valve
129
Immersion dieresis causes a diver to lose how much liquid per hour?
250 to 500cc of fluids per hour
130
What is included in the primary and secondary emergency kits?
Primary kit: Therapeutic and diagnostic
Secondary kit: Equipment and medicine not need to be immediately available
131
What are the authorized oxygen extensions on a TT5?
(2) 20 min oxygen periods at 30 feet
132
Because available facilities may differ, who authorized to augment the emergency kits to suit the local needs?
DMO or DMT
133
In all treatments what is your first duty?
To do no harm
134
What are the tender O2 breathing requirements for TT5?
TT5: Breaths 100% O2 from 30ft. stop to the surface. If tender has previous hyperbaric in the last 18 hours, an additional 20 minutes is required prior to ascent.
135
What are the tender O2 breathing requirements for TT6?
TT6: Breaths 100% O2 during the last 30 min at 30ft. for an unmodified table or where there was one extension at 30 or 60 feet. If there has been more than one extension, the O2 breathing at 30ft. gets extended to 60 minutes. If the tender has had hyperbaric exposure in the last 18 hours an additional 60 minutes is taken at 30ft.
136
What are the tender O2 breathing requirements for TT6A?
TT6A: tender breaths 100% O2 during the last 60 minutes at 30ft. and during ascent to the surface for an unmodified table or where there has been only one extension at 30 or 60 feet. If more than 1 extension has been taken , the O2 breathing at 30ft. is increased to 90 minutes. If the tender has had hyperbaric exposure in the last 18 hours an additional 60 minutes of O2 is taken at 30 feet.
137
What are the tender O2 breathing requirements for TT9?
TT9: Tender breathes 100 percent O2 during last 15 minutes at 45 feet and during ascent to the surface regardless of ascent rate used.
138
Is an air break required prior to / after ascent on a TT5?
Prior: No
After: Yes
139
Is an air break required prior to / after ascent on a TT6?
Prior: Yes
After: Yes
140
What actions are taken if a tender’s oxygen breathing obligation exceeds the table stay time at 30 fsw?
Extend the time at 30 fsw to meet these obligations if patient’s condition permits
Otherwise, administer O2 to the tender to the limit allowed by the treatment table and observe the tender on the surface for 1 hour for symptoms of DCS.
141
When may termination of resuscitation for a pulseless diver be considered?
If the stricken diver remains pulseless after 20 minutes
142
What actions are taken if a patient cannot tolerate oxygen at 45 feet on a TT9?
The table can be modified to allow a treatment depth of 30 feet.
The oxygen breathing time can be extended to a maximum of 3 to 4 hours.
