Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
113 Cards in this Set
- Front
- Back
|
As a basic rule, any diver who has obtained a breath of compressed gas from any source at depth, whether from diving apparatus or from a diving bell, and who surfaces unconscious, loses consciousness, or has any obvious neurological symptoms within 10 minutes of reaching the surface, must be assumed to be suffering from what diving disorder?
|
Arterial gas embolism
|
|
|
What are your actions for a diver who surfaces unconscious and recovers when exposed to fresh air?
|
Perform a neurological evaluation to rule out arterial gas embolism.
|
|
|
Victims of near-drowning who have no neurological symptoms should be carefully evaluated by a DMO for what disorder?
|
Pulmonary aspiration
|
|
|
What are some signs and symptoms of AGE?
|
Near immediate onset of dizziness, paralysis or weakness in the extremities, large areas of abnormal sensation (paresthesias), vision abnormalities, convulsions or personality changes. During ascent, the diver may have noticed a sensation similar to that of a blow to the chest. The victim may become unconscious without warning and may stop breathing. Additional symptoms of AGE include: Extreme fatigue, difficulty in thinking, vertigo, nausea and/or vomiting, hearing abnormalities, bloody sputum, loss of control of bodily functions, tremors, loss of coordination, numbness.
|
|
|
What is the treatment for AGE?
|
Initial compression to 60 fsw. If symptoms are improved within the first oxygen breathing period, then treatment is continued using Treatment Table 6. If symptoms are unchanged or worsen, assess the patient upon descent and compress to depth of relief (or significant improvement), not to exceed 165 fsw. Complete 30 min period breathing air or treatment gas on Table 6A.
|
|
|
What conditions must not be overlooked when treating a stricken diver for an arterial gas embolism?
|
Symptoms of subcutaneous/mediastinal emphysema, pnuemothorax and/or pnuemopericardium may also be present. In all cases of AGE the possible presence of these associated conditions should not be overlooked.
|
|
|
You are treating for AGE at 60 feet, symptoms are unchanged or worsen, you decide to compress to depth of relief (or significant improvement), not to exceed 165 fsw. You complete a 30 min period on Table 6A and determine more time is needed at depth. What is the maximum time you can spend there and what treatment table will you come out on?
|
120 minutes, Treatment Table 4. If a shift to a TT-4 is contemplated a DMO must be consulted.
|
|
|
For a diver with no pulse or respirations, if a qualified provider with the necessary equipment (i.e., AED) can administer the potentially lifesaving therapies within ______ minutes, the stricken diver should be kept at the surface until a pulse is obtained.
|
10 minutes
|
|
|
If defibrillation is not available and a Diving Medical Officer (DMO) is not present, what should the Diving Supervisor do for a diver with no pulse or respirations?
|
Compress the diver to 60 feet, continue CPR and attempt to contact a DMO
|
|
|
You’ve compressed a pulseless diver to 60 feet while performing CPR. If defibrillation becomes available within _____ minutes, the pulseless diver shall be brought to the surface at 30 fpm and defibrillated when appropriate on the surface.
|
20 minutes - Current data indicates that successful restoration of a perfusing rhythm after 20 minutes of cardiac arrest with only CPR is unlikely. AVOID RECOMPRESSING A PULSELESS DIVER who has failed to regain vital signs.
|
|
|
What are the symptoms Type I decompression sickness?
|
Joint pain (musculoskeletal or pain-only symptoms) and symptoms involving the skin (cutaneous symptoms), or swelling and pain in lymph nodes.
|
|
|
What is the most common symptom of decompression sickness?
|
Joint pain
|
|
|
Describe the characteristics of Type 1 joint pain.
|
The pain may be mild or excruciating. The most common sites of joint pain are the shoulder, elbow, wrist, hand, knee, and ankle. The characteristic pain of Type I decompression sickness usually begins gradually, is slight when first noticed and may be difficult to localize. It may be located in a joint or muscle, may increase in intensity, and is usually described as a deep, dull ache. The pain may or may not be increased by movement of the affected joint, and the limb may be held preferentially in certain positions to reduce the intensity (so-called guarding). The hallmark of Type I pain is its dull, aching quality and confinement to particular areas. It is always present at rest and is usually unaffected by movement.
|
|
|
Any pain occurring in the abdominal and thoracic areas, including the hips, should be considered as symptoms arising from spinal cord involvement and treated as what?
|
Type II decompression sickness
|
|
|
What type of pain only symptoms may indicate spinal cord involvement and treated as Type II DCS?
|
1. Pain localized to joints between the ribs and spinal column or joints between the ribs and sternum.
2. A shooting-type pain that radiates from the back around the body (radicular or girdle pain). 3. A vague, aching pain in the chest or abdomen (visceral pain). |
|
|
What Type I symptoms do not require treatment?
|
Itching and skin rash
|
|
|
What is the most common skin manifestation of Type I decompression sickness?
|
Itching
|
|
|
What is mottling or marbling of the skin treated as (cutis marmorata)?
|
Type II decompression sickness
|
|
|
Describe how pain and swelling of the lymph nodes responds to recompression treatment.
|
It may provide prompt relief from pain. The swelling, however, may take longer to resolve completely and may still be present at the completion of treatment.
|
|
|
What is the treatment for Type I DCS?
|
Recompress to 60 feet. If symptoms resolve in the first 10 minutes, treat on TT-5. If symptoms are not resolved within the first 10 minutes, treat on a TT-6
|
|
|
What are you actions if a full neurological exam is not completed before initial recompression for treatment of Type I DCS?
|
Treat as a Type II symptom
|
|
|
Type II, or serious, symptoms are divided into what three categories?
|
Neurological, inner ear (staggers), and cardiopulmonary (chokes)
|
|
|
What are the nuerological symptoms of Type II DCS?
|
These symptoms may be the result of involvement of any level of the nervous system. 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, or motor performance alterations are the most common symptoms. Disturbances of higher brain function may result in personality changes, amnesia, bizarre behavior, lightheadedness, lack of coordination, and tremors. Lower spinal cord involvement can cause disruption of urinary function. Tinnitus (ringing in the ears), hearing loss, vertigo, dizziness, nausea, and vomiting.
|
|
|
Inner ear decompression sickness (staggers) occurs most often during what type of diving?
|
Helium-oxygen diving and during decompression when the diver switched from breathing helium-oxygen to air.
|
|
|
What are the symptoms of Inner Ear Decompression Sickness?
|
Tinnitus (ringing in the ears), hearing loss, vertigo, dizziness, nausea, and vomiting.
|
|
|
Inner ear decompression sickness should be differentiated from what other two disorders with similar symptoms?
|
-Inner ear barotrauma
-Nuerological decompression sickness involving the cerebellum. Typically rapid involuntary eye movement (nystagmus) is not present in cerebellar DCS. |
|
|
What is Chokes (cardiopulmonary symptoms)?
|
Profuse intravascular bubbling in the lungs which may due to congestion of the lung circulation.
|
|
|
What are the symptoms of Chokes?
|
May 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. Careful examination for signs of pneumothorax should be performed on patients presenting with shortness of breath.
|
|
|
Since most symptoms of Type II DCS and AGE are the same, how do you differentiate diagnosis between the two?
|
Time of onset. AGE usually occurs within 10 minutes of surfacing
|
|
|
What is the treatment for Type II DCS?
|
Initial compression to 60 fsw. If symptoms are improved within the first oxygen breathing period, then treatment is continued on a Treatment Table 6. If severe symptoms (e.g. paralysis, major weakness, memory loss) are unchanged or worsen within the first 20 minutes at 60 fsw, assess the patient during descent and compress to depth of relief (or significant improvement), not to exceed to 165 fsw. Treat on Treatment Table 6A. To limit recurrence, severe Type II symptoms warrant full extensions at 60 fsw even if symptoms resolve during the first oxygen breathing period.
|
|
|
In rare instances, decompression sickness may develop in the water while the diver is undergoing decompression. What would the predominant symptom usually be?
|
Joint pain
|
|
|
At what point during decompression will in-water decompression sickness is most likely to appear?
|
At the shallow decompression stops just prior to surfacing. Some cases, however, have occurred during ascent to the first stop or shortly thereafter.
|
|
|
If a diver has had an uncontrolled ascent and has any symptoms, what is your course of action?
|
He should be compressed immediately in a recompression chamber to 60 fsw. Conduct a rapid assessment of the patient and treat accordingly.
If the diver surfaced from 50 fsw or shallower, begin Treatment Table 6. If the diver surfaced from a greater depth, compress to 60 fsw or the depth where the symptoms are significantly improved, not to exceed 165 fsw, and begin Treatment Table 6A. Consultation with a Diving Medical Officer should be obtained as soon as possible. For uncontrolled ascent deeper than 165 feet, the diving supervisor may elect to use Treatment Table 8 at the depth of relief, not to exceed 225 fsw. |
|
|
For altitude decompression sickness, if only joint pain was present but resolved before reaching one ata from altitude, what is your course of action?
|
Treated with two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation
|
|
|
For altitude decompression sickness, if other symptoms or if joint pain symptoms are present after return to one ata, what is your course of action?
|
Treat 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?
|
1. Compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow
2. Allow sufficient time for bubble resorption 3. Increase blood oxygen content and thus oxygen delivery to injured tissues |
|
|
What is the descent rate for TT 1A, 2A, 3, 4, 5, 6, 6A, 7, and 9? What about TT- 8?
|
20 feet per minute for except TT-8 which is as fast as tolerable
|
|
|
When beginning a treatment table, at what point do you put the patient on oxygen?
|
Upon reaching a treatment depth of 60 fsw or shallower
|
|
|
When treating Type I pain on an air treatment table, what is the determining factor for what treatment table you will use?
|
Use Air Treatment Table 1A if pain is relieved at a depth less than 66 feet. If pain is relieved at a depth greater than 66 feet, use Treatment Table 2A.
|
|
|
What is a Treatment Table 3 used for?
|
Treatment of serious symptoms where oxygen cannot be used. Use Treatment Table 3 if symptoms are relieved within 30 minutes at 165 feet. If symptoms are not relieved in less than 30 minutes at 165 feet, use Treatment Table 4.
|
|
|
When transporting how should he be trasported (postition, monitoring, considerations etc..)
|
-Kept lying supine (horizontally), never head down
-Kept warm -Monitor ABC's -Pay special attention to the possibilty of mutiple conditions and underlying issues -If needed, start IV prior to transport |
|
|
Always have the patient breathe 100 percent oxygen during transport, if available. If symptoms of decompression sickness or arterial gas embolism are relieved or improve after breathing 100 percent oxygen, what should you do?
|
The patient should still be recompressed as if the original symptom(s) were still present
|
|
|
If a patient is moved by helicopter or other unpressurized aircraft, the aircraft should be flown as low as safely possible, lower than what altitude is preferred?
|
Less than 1,000 feet, use of an EEHS should be considered if available
|
|
|
To transport a patient, if available, always use aircraft that can be pressurized to ______ atmosphere.
|
One atmosphere
|
|
|
Recompression in the water should be considered an option of last resort, to be used only when no recompression facility is on site, symptoms are significant and there is no prospect of reaching a recompression facility within a reasonable timeframe of ____ - ____ hours.
|
12–24 hours
|
|
|
When may an uncertified chamber be used?
|
In an emergency, if in the opinion of a qualified Chamber Supervisor (DSWS Watchstation 305), it is safe to operate.
|
|
|
What must be done prior to recompressing a diver in the water as a treatment alternative because no chamber is available?
|
The stricken diver should begin breathing 100 percent oxygen immediately (if it is available). Continue breathing oxygen at the surface for 30 minutes before committing to recompress in the water. If symptoms stabilize, improve, or relief on 100 percent oxygen is noted, do not attempt in-water recompression unless symptoms reappear with their original intensity or worsen when oxygen is discontinued. Continue breathing 100 percent oxygen as long as supplies last, up to a maximum time of 12 hours. The patient may be given air breaks as necessary. If surface oxygen proves ineffective after 30 minutes, begin in-water recompression.
|
|
|
What protocol do you follow for in-water recompression using air?
|
Follow Air Treatment Table 1A as closely as possible.
-Do not use SCUBA unless you have to, maintain constant comms, keep at least one diver with patient at all times, plan UBA/cylinder shifts, have ample tenders. If the depth is too shallow for full treatment according to Air Treatment Table 1A: 1. Recompress the patient to the maximum available depth. 2. Remain at maximum depth for 30 minutes. 3. Decompress according to Air Treatment Table 1A. Do not use stops shorter than those of Air Treatment Table 1A. |
|
|
What protocol do you follow for in-water recompression using oxygen?
|
1. Put the stricken diver on the UBA and have the diver purge the apparatus at least three times with oxygen.
2. Descend to a depth of 30 feet with a standby diver. 3. 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. 4. Decompress to the surface by taking 60-minute stops at 20 feet and 10 feet. 5. After surfacing, continue breathing 100 percent oxygen for an additional 3 hours. 6. If symptoms persist or recur on the surface, arrange for transport to a recompression facility regardless of the delay. |
|
|
What should the occurrence of Type II symtoms after in-water recompression be considered as?
|
It is an ominous sign and could progress to severe, debilitating decompression sickness. It should be considered life threatening
|
|
|
What is a Treatment Table 5 used for?
|
1. Type I DCS (except cutis marmorata) when a complete neurological examination has revealed no abnormality. Repeat nuero upon arrival at 60'
2. Asymptomatic omitted decompression 3. Treatment of resolved symptoms following in-water recompression 4. Follow-up treatments for residual symptoms 5. Carbon monoxide poisoning 6. Gas gangrene |
|
|
What is a Treatment Table 6 used for?
|
1. Arterial gas embolism
2. Type II DCS symptoms 3. 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 4. Cutis marmorata 5. Severe carbon monoxide poisoning, cyanide poisoning, or smoke inhalation 6. Asymptomatic omitted decompression 7. Symptomatic uncontrolled ascent 8. Recurrence of symptoms shallower than 60 fsw |
|
|
What is a Treatment Table 6A used for?
|
To treat arterial gas embolism or decompression symptoms when severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw.
|
|
|
What is a Treatment Table 4 used for?
|
Is used when it is determined that the patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw, while on a TT-6A. A DMO shall be consulted before the shift to a TT-4
|
|
|
What is the minimum and maximum time that can be spent at 165’ or depth of relief on a TT-4?
|
Minimum 30 minutes and maximum 120 Minutes
|
|
|
How long are the O2 periods once you get to 60 fsw on a TT-4 or TT-7?
|
25 minutes oxygen, 5 minute air break
|
|
|
Both the patient and tender on a TT-4 must breathe oxygen for at least __________ (eight 25-minute oxygen, 5-minute air periods), beginning no later than _____________ before ascent from 30 feet is begun.
|
4 hours, 2 hours
|
|
|
When using Treatment Table 7, a minimum of ____________ should be spent at 60 feet.
|
12 hours
|
|
|
When using a TT-7, normally, _______ oxygen breathing periods are alternated with _____hours of continuous air breathing.
|
Four oxygen breathing periods, 2 hours
|
|
|
When may a patient sleep and eat during a treatment in the chamber?
|
The patient may sleep anytime except when breathing oxygen deeper than 30 feet. While sleeping vital signs should be monitored as patients condition dictates. Food may be taken at any time by chamber occupants
|
|
|
What is a Treatment Table 8 used for?
|
For treating deep uncontrolled ascents when more than 60 minutes of decompression have been missed.
|
|
|
What is a Treatment Table 9 used for?
|
1. Residual symptoms remaining after initial treatment of AGE/DCS
2. Selected cases of carbon monoxide or cyanide poisoning 3. Smoke inhalation |
|
|
Treatment Table 9, is a hyperbaric oxygen treatment table providing ______ minutes of oxygen breathing at ________ feet. What is the tenders O2 requirement
|
90 minutes, 45 feet. Tender breathes O2 for the last :15 and during ascent to the surface
|
|
|
In addition to individuals suffering from diving disorders, U.S. Navy recompression chambers are also permitted to conduct emergent hyperbaric oxygen (HBO2) therapy to treat individuals suffering from what other medical disorders? Who approves these treatments?
|
Cyanide poisoning, carbon monoxide poisoning, gas gangrene, smoke inhalation, necrotizing soft-tissue infections, or arterial gas embolism arising from surgery, diagnostic procedures, or thoracic trauma. Authorization from BUMED Code M3B42 shall be obtained prior to treatment.
|
|
|
What is the emergency, minimum and optimum manning levels for chamber operations?
|
-Emergency: 2 (Chamber Sup and inside tender
-Minimum: 3 (Chamber sup, inside tender, outside tender) -Optimum: 4 (Chamber sup, inside tender, outside tender #1, comms and logs) |
|
|
If the chamber is equipped with a life-support system so that ventilation is not required and an oxygen analyzer is available, the oxygen level should be maintained between _____ percent and _____ percent.
|
19 percent and 25 percent
|
|
|
Chamber carbon dioxide level should not be allowed to exceed what level during a treatment table?
|
1.5 percent SEV (11.4 mmHg)
0.78% at 30' 0.53% at 60' 0.25% at 165' |
|
|
When may CO2 absorbent be used beyond the expiration date when used in a recompression chamber?
|
When the chamber is equipped with a CO2 monitor. Bags shall be double bagged and labled with the expiration date on the container.
|
|
|
A chamber temperature below ______ °F is always desirable, no matter which treatment table is used.
What are the allowable ranges for treatments in the chamber? |
85°F
Temp in F Time allowed TT allowed Under 85 Unlimited All 85-94 6 hours 1A,5,6,6A,9 95-104 2 hours 5, 9 Above 104 Intolerable None *Never deviate from prescribed limits unless qualified medical personal can evaluate risk to gain |
|
|
What are the allowbale thermometers in the chamber?
|
-Electronic
-Bimettalic -Alcohol -Liquid crystal Never use thermometers containing mercury |
|
|
How much and what type of fluid shall be given to the patient over the course of a Treatment Table 5 or 6?
|
One to two liters of water, juice, or a non carbonated drink.
|
|
|
When should patients be considered for IV fluids?
|
Patients with Type II symptoms, or symptoms of arterial gas embolism. Stuporous or unconscious patients should always be given IV fluids, using large-gauge plastic catheters.
|
|
|
If IV is given to a patient, at what rate should be kept dripping at?
|
75 to 100 cc/hour
|
|
|
What type of IV fluid is recommended to be used during recompression therapy?
|
Isotonic fluids (Lactated Ringer’s Solution, Normal Saline)
Avoid solutions containing glucose (Dextrose) if brain or spinal cord injury is present. Intravenously administered glucose may worsen the outcome. |
|
|
How much and what type of urine output means adequate fluid is being given? What is the concern if urine output is low?
|
When clear colorless urine output is at least 0.5cc/kg/hr is an indication that adequate fluid is being provided and the patient is hydrated. The bladder could be paralyzed due to DCS type II, if that is the case admister a urinary catheter filling the ballon with liquid, not air.
*1 cc (cubic centimeter) = 1 ml (milliliters) |
|
|
What are the chamber ventilation requirements in regards to treatments?
|
Ventilation is required for chambers without carbon dioxide scrubbers and atmospheric analysis. Ventilation rates are as follows:
- 2 acfm for each resting occupant (patient) - 4 acfm for each active occupant (tender) |
|
|
What are the requirements for double lock recompression chambers access to patients during treatment?
|
Access to occupants is the availability to pass in items such as food, water, and drugs and the ability to pass out urine, exrement, and trash. Never attempt a treatment longer than a TT-6 unless there is access to occupants.
TT-4, 7, and 8 require double lock chambers. |
|
|
What are the responsibilities of the Inside Tender?
|
First rule is DO NO FURTHER HARM
-Releasing the door latches after seal is made -Communicating with outside personnel -Providing first aid as required by the patient -Administering treatment gas to the patient -Providing normal assistance to patient as required -Ensure hearing protection is wore (1/16" hole) -Ensure patient is positioned to permit blood flow |
|
|
What are the requirments for use of a Non-Diver as an Inside Tender?
|
-NAVEDTRA 43910 Inside Tender PQS
-Current diving physical exam -Conformance to Navy physical standards -Diver candidate pressure test |
|
|
Are there any requirements for using specialized medical care? I.e. surgeon, respiratory therapist, etc.
|
Emergency situations that require specialized medical care should always have the best medical personnel. These emergency exposures require no special prerequisites but a qualified Inside Tender is required in the chamber to handle any system requirements
|
|
|
What is the required surface interval for Inside Tenders during consecutive treatments?
|
18 hours- TT 1A, 2A, 3, 5, 6, and 6A
48 hours- TT 4, 7, and 8 *Within 18 hours for 5, 6, and 6A requires requires additional O2 time for tenders Wait times for TT 1A, 2A, 3, 4, 7, and 8 shall be strictly observed. |
|
|
When are the high oxygen mixtures used, what are the depth limits and ranges of gases?
|
Gas mixtures are highly recommended when at treatment depths deeper than 60', the treatment gases will provide a PPO2 between 1.5 and 3.0 ata at depth.
0-60': 100% O2 (1.00-2.82 ata PPO2) 61'-165': 50/50 HEO2 or N2O2 (1.42-3.00 ata PPO2) 166'-225' : 64/36 HEO2 Only (2.17-2.81 ata PPO2) |
|
|
CNS oxygen toxicity is unlikely in resting individuals at chamber depths of _____' and shallower and very unlikely at ______' or shallower. However patients with severe _________ DCS or AGE may be abnormally sensitive to CNS oxygen toxicity.
|
50', 30', Type II
|
|
|
What are the procedures for handling CNS oxygen toxicity in the chamber?
|
1st symptom- Off O2, wiat :15 after all symptoms have subsided and resume at point of interruption.
2nd symptom/Convulsion- Off O2, after all symptoms have subsided and px is relaxed and breathing normally ascend 10' at 1' per minute. Resume at POI. 3rd symptom/2nd convulsion- Off O2, consult DMO |
|
|
When could you see pulmonary oxygen toxicity during treatments? What are the symptoms and how do you treat it?
|
TT 4, 7, and 8 or with repeated TT 5, 6, 6A.
Symptoms include end inspiratory discomfort, progressing to substernal burning and severe pain on inspiration. - For a patient responding well to treatment, off O2 consult DMO - For if patient is still improving or symptoms worsen when removed from O2 modify oxygen periods as needed with consultation from DMO |
|
|
What are your procedures for loss of oxygen during treatment?
-Repaired within :15 -Repaired after :15 but before 2 hours -Cannot be restored in 2 hours |
-Repaired within :15: Maintain depth, resume at POI
-Repaired :15 to 2 hours: Maintain depth, resume at POI using max O2 extensions for TT 5, 6, and 6A. No compensation needed for TT 4, 7, and 8. -If it cannot be restored in 2 hours switch to a comparable air table at current depth if at 60' or shallower. Do not exceed 1 fpm between stops, if symptoms worsen or deeper than 60' is needed switch to a TT-4, consult with DMO. |
|
|
What special considerations must be adhered to when performing treatments at altitude?
|
-Zero depth gauges prior to treatment
-Tenders locking in for brief periods shall adhere to the diving at altitude procedures -Tenders remaining in the chamber for the full duration of treatment must adhere to the tender O2 breathing requirements for provided altitudes. If tender O2 requirement exceeds prescribed stop time at 30' extend stop time to meet requirement, If stop time cannot be extended observe tender on surface for one hour. Requirements pertain to all tenders regardless of equalibration, Contact NEDU for guidance on tables other than 5, 6, 6A. |
|
|
What is the required surface interval for Inside Tenders from treatment to diving?
*TT- 5, 6, 6A, 1A, 2A, or 3 *TT- 4, 7, and 8 |
-TT- 5, 6, 6A, 1A, 2A, or 3
No "D": 18 hour SI "D": 24 hour SI -TT- 4, 7, and 8 "D" or No "D": 48 hour SI |
|
|
How long must you observe a patient and Inside Tender after treatment for recurrence of symptoms?
|
-2 hours for patients treated on a TT-5
-6 hours for patients who have been treated for type II or required a TT-6 for type I symptoms. Times may be shortened upon recommendation of a DMO provided the patient can return within :30 Do not release patient without consulting a DMO All px should remain with in :60 of chamber for 24 hrs. Inside tender should remain in vicinity of chamber for one hour and for TT-4, 7, 8 within :60 for 24 hours. |
|
|
What is the required surface interval before flying after treatments?
-Patients -Tenders |
Patients
-Residual symptoms: concurrence of DMO. -Complete relief: 72 hours Tenders -TT 5, 6, 6A, 1A, 2A, 3: 24 hours -TT 4, 7, 8: 72 hours |
|
|
If emergency transportation is required following a treatment what considerations must be met?
|
-Only done on recommendation of DMO
-Aircraft prussureized to 1 ata, or unpressurized aircraft flown at less than 1,000' -Breathe 100% O2 during transport - Use EEHS to maintain 1 ata, if available |
|
|
What are the requirements and considerations for treatment of residual symptoms?
|
-DMO must be consulted, NEDU or NDSTC if needed
-Do not delay, > than one week benifit is not likely -Treat residual sx until no further benifit is noted. -Discontinue if no benifits following 2 consecutive tx -Persistent type II: Daily TT6 or 2 a day w/ TT 5 or 9 -Pulmonary O2 tox following long/repeat exposures -5 days consecutive tx requires at least 1 day break |
|
|
Discuss the guidelins and requirements for returning to diving following recompression treatment.
|
-Type I: 7 days if successful completion fo treatment and apporval by DMO
-AGE/Type II: 30 days after initial tx and diagnosis by DMO, if the tx is successful and no neurological deficits persist. If sx persists beyond initial tx BUMED waiver for a return to diving is required, refer to MANMED for info. |
|
|
Who can modify treatments?
|
Only DMOs with sub specialty codes 16U0 or 16U1 with the concurrence of the CO or OIC.
|
|
|
What is the procedure for a death during treatment?
|
Consult DMO before aborting any treatment!
-If aborting following initial recompression to 60, 165, 225 decompress on the Air/O2 schedule. Air "D" table. -If death occurs after leaving initial tx depth on TT 6/6A decompress the tenders at 30 fpm to 30' and them fulfil tender O2 requirements, including O2 30' to the surface at a rate of 1 fpm. -If death occurs after leaving initial treatment depth on a TT 4/8 or beginning a TT-7 continue the table as prescribed or consult NEDU for customized schedule. |
|
|
What is the procedure for impending natural disasters or mechanical failure?
|
1. If deeper than 60', go directly to 60'
2. Place all occupants on O2 at 60', select the Air/O2 schedule appropriate for max depth obtained and total elapsed time since treatment began. 3. Perform the sum of all missed decompression stops deeper than current depth at the current depth on O2. Decompress on the Air/O2 schedule as perscribed, completing as much as possible. 4. When time has run out, ascend to surface on oxygen at a rate of 10 fpm (try not to exceed) and keep occupants on 100% O2 during evacuation. 5. Immediatly evacuate to nearest chamber, if no symptoms occured use TT-6 as a minimum. |
|
|
What is adjunctive therapy and how is adjunctive therapy guidance seperated?
|
Adjunctive therapy refers to any treatment that is used in conjunction with another to increase the chance of cure, or to increase the first treatment's efficacy. In other words, adjunctive therapy acts as an aid to the primary treatment. It is seperated into two sections
-Decompression sickness -Arterial gas embolism |
|
|
What are the guidelines administering drug therapy?
|
Drug therapy shall be administered only after consultation with a DMO by qualified Inside Tenders adaquately trained and capable of administering prescribed medications.
|
|
|
Discuss the following adjunctive therapy for decompression sickness?
-Surface O2 -Fluids -Anticoagulants -Asprin/non-steroidal anti-inflammatory drugs -Steroids -Lidocaine -Enviornmental temperature |
-Surface O2: Use at 15 lpm for up to 12hrs
-Fluids: Mouth or IV unless chokes present. 50/50 glucose/electrolyte by mouth . Avoid fluid overloading -Anticoagulants: Do not use, exception is lower extremity weakness/paralysis due to deep venous thrombosis (DMV). Refer to dive manual -Asprin/non-steroidal anti-inflammatory drugs: Not recommended due to worsening hemorrhage in spinal cord or inner ear DCS -Steroids: May worsen outcome of CNS injury -Lidocaine: Not recommened -Enviornmental temps: Do not allow px to become hot |
|
|
Discuss the following adjunctive therapy for Arterial Gas Embolism?
-Surface O2 -Lidocaine -Fluids -Anticoagulants -Asprin/non-steroidal anti-inflammatory drugs -Steroids |
-Surface O2: Use at 15 lpm for up to 12hrs
-Lidocaine: Useful for tx of AGE, refer to Dive Manual -Fluids: Special caution must be taken to not overload px with fluids, use urinary cathater for unconsciousnes -Anticoagulants: Do not use, exception is lower extremity weakness/paralysis due to deep venous thrombosis (DMV). Refer to dive manual -Asprin/non-steroidal anti-inflammatory drugs: Not recommended for use with AGE -Steroids: May worsen outcome of CNS injury |
|
|
Discuss the requirements for primary and secondary medical kits.
|
Primary- Contains diagnostic therapeutic equipment. The primary kit shall be inside the chamber during all treatments
Secondary- Contains equipment and medicine that does not need to be immediately available, but can be locked-in when required. Both kits shall have a tamper seal and be inventoried every time it is opened and unopened kits shall be inventoried quarterly. |
|
|
What are the steralization requirements for sterile equipment in the medical kits?
|
Unless adaquately sealed against increased pressure (i.e. vacuum packed) sterile supplies should be re-sterilized after each pressure exposure, or if not exopsed, at experation date.
|
|
|
Who can modify the medical kit requirements?
|
The responsible Diving Medical Officer or Diving Medical technician to support local needs. The precribed primary and secondary medical kit inventories shall be used as minimum equipment
|
|
|
In regards to a recompression chamber facility what are the requirements for a portable Monitor-Defibrillator (AED) and Advanced Cardiac Life Support (ACLS) Drugs and Equipment?
|
-All commands shall maintain an AED and if a DMO is assigned augment a fully capable monitor defibrillator.
-All commands that participate in area bends watch shall mainatin ACLS drugs recommended by the American Heart Association. In, addition, medications to treat for anaphylaxis shall be maintained for a minimum of one patient. |
|
|
An assessment of the patient must be made within ___ minutes. If a stricken diver remains pulseless after ___ minutes, termination of resuscitation may be considered.
|
20 minutes for both
|
|
|
A DMO must be consulted before commiting to what two treatment tables?
|
TT-4 and TT-7
|
|
|
What is the ascent rate for all treatment tables?
|
TT- 1A, 2A, 3, 4, 5, 6: 1 fpm
TT-6A: 3 fpm for 165' to 60' followed by 1 fpm 60' to 0' TT-9: 20 fpm, but can be slowed to 1 fpm if needed |
|
|
Describe the following in regards to a TT-5
1.Total time 2.Total periods at 60 and 30 3.Extensions allowed |
1. :135 (2 hours 15 minutes)
2. 2 :20 O2 periods @ 60', 1 :20 O2 period @ 30' * Can be extended 2 :20 O2 periods @ 30', air breaks not required between 30' O2 periods or prior to ascent to the surface. |
|
|
Describe the following in regards to a TT-6
1.Total time 2.Total periods at 60 and 30 3.Extensions allowed |
1. :285 (4 hours 45 minutes)
2. 2 :20 O2 periods @ 60', 1 :20 O2 period @ 30' Extentions include 2 :60 O2 periods @ 30' and/or 2 :20 O2 periods @ 60' *Air break not required prior to ascent to surface. |
|
|
Describe the following in regards to a TT-6A
1.Total time 2.Total periods at 60 and 30 3.Extensions allowed |
1. :350 (5 hours 50 minutes)
2. 1 :30 stop at depth of relief NTE 165', 3 :20 O2 periods @ 60', 2 :60 O2 period @ 30' Extentions include 2 :60 periods @ 30' and/or 2 :20 periods @ 60' *Air break not required prior to ascent to surface.. |
|
|
What are the tender oxygen breathing requirements for a TT-5 from surface to 2499' elevation?
|
The only time a tender must breathe O2 at 30' on a TT-5 is when there has been previous hyperbaric exposure within 18 hours.
TT-5 :20 TT-6/6A :60 In addition breathe oxygen from 30' to the surface. |
|
|
What are the tender oxygen breathing requirements for a TT-6 from surface to 2499' elevation?
|
Up to one extension @ 30' or 60'= :30
More than one extension= :60 Previous hyperbaric exposure within 18 hours= TT-5 :20 TT-6/6A :60 Add the required time to be spent on oxygen at :30, in addition breathe oxygen from 30' to the surface. |
|
|
What are the tender oxygen breathing requirements for a TT-6A from surface to 2499' elevation?
|
Up to one extension @ 30' or 60'= :60
More than one extension= :90 Previous hyperbaric exposure within 18 hours= TT-5 :20 TT-6/6A :60 Add the required time to be spent on oxygen at :30, in addition breathe oxygen from 30' to the surface. |
