CH 17 Dive Manual

Question 1

When should a patient be directed to the highest level of medical care?

Answer 1

When diagnosis or treatment are not clear

Contact the Diving Medical Officers at NEDU or NDSTC for guidance.

Question 2

What types of diving does the recompression procedures apply to?

Answer 2

• surface-supplied
• open and closed circuit
• SCUBA diving

Also applicable to recompression chamber operations, whether breathing air, nitrogen-oxygen, helium-oxygen, or 100 percent oxygen.

Question 3

What is the effectiveness rate of U.S. Navy recompression treatment procedures?

Answer 3

Over 90 percent effective in relieving symptoms

Question 4

What procedures require special training and must not be attempted by untrained individuals?

Answer 4

Starting intravenous (IV) fluid lines and inserting chest tubes.

Question 5

Can treatment tables be initiated without consulting a Dive Medical Officer?

Answer 5

Yes, but a DMO should always be contacted at the earliest possible opportunity.

Question 6

What is the role of the Chamber Supervisor?

Answer 6

To oversee the recompression chamber team

Question 7

In what situations is a recompression chamber team assembled?

Answer 7

When a recompression chamber is part of a diving operation or maintained as an area response requirement.

Question 8

Who should accompany the patient with symptoms of serious DCS or AGE when treating the patient inside a chamber?

Answer 8

A Diving Medical Technician (DMT) or Diving Medical Officer (DMO) should accompany the patient inside the chamber

Basic Life Support (BLS) or advanced medical support may be required.

Question 9

Who can provide specialized medical care to a patient in the chamber?

Answer 9

The best qualified person available, which may include a non-diving surgeon, respiratory therapist, or Independent Duty Corpsman (IDC)

No special medical or physical prerequisites exist for emergency exposures.

Question 10

What is the role of the Diving Officer in recompression chamber operations?

Answer 10

Responsible for the safe conduct of operations and reporting to the Commanding Officer

This includes presenting the operational status and issues.

Question 11

Fill in the blank: A qualified _______ is required inside the chamber at all times.

Answer 11

Inside Tender

This is essential for patient care during recompression treatments.

Question 12

True or False: Inside tenders and additional personnel may be locked in and out during treatments.

Answer 12

True

Chamber periods should be kept within no-decompression limits if possible.

Question 13

What is the total minimum manning level for emergency diving operations?

Answer 13

3

Supervisor / outside tender / inside tender

Question 14

What are the primary objectives of recompression treatment?

Answer 14

• 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

Table 17-1 provides further details on recompression treatments.

Question 15

What should be done promptly and adequately in recompression treatment?

Answer 15

Treatment

The effectiveness of treatment decreases as the length of time between the onset of symptoms and the treatment increases.

Question 16

True or False: Minor symptoms should be ignored in diving disorders.

Answer 16

False

Seemingly minor symptoms can quickly become major symptoms.

Question 17

What should be followed unless changes are recommended by a Diving Medical Officer?

Answer 17

The selected treatment table

If multiple symptoms occur, treat for the most serious condition.

Question 18

Which treatment tables are more effective for diving disorders?

Answer 18

Oxygen treatment tables

Air treatment tables should only be used after oxygen system failure or intolerable patient oxygen toxicity problems.

Question 19

When should Air Treatment Tables be used?

Answer 19

Only as a last resort when oxygen is not available

Question 20

What is the descent rate for all oxygen treatment tables?

Answer 20

20 feet per minute

Upon reaching a treatment depth, place the patient on oxygen/treatment gas

Question 21

What is used for treatment depths deeper than 60 fsw?

Answer 21

Treatment gas if available

Treatment Table 4 should always be used with oxygen if it is available.

Question 22

Fill in the blank: Use Treatment Table 3 for treatment of serious symptoms where oxygen cannot be used if symptoms are relieved at a depth greater than _____ feet.

Answer 22

66

Treatment Table 2A is used if pain is relieved at a depth greater than 66 feet.

Question 23

What should be done if pain is relieved at a depth less than 66 feet?

Answer 23

Use Treatment Table 1A

This is part of the protocol when oxygen is not available.

Question 24

What are the primary objectives of recompression treatment?

Answer 24

• 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

Crush
Reabsorb
Increase PPO2

Question 25

What should be done when determined that recompression treatment is needed?

Answer 25

Treat promptly and adequately ## Footnote Timeliness is crucial as the effectiveness of treatment decreases with time.

Question 26

What happens if seemingly minor symptoms are ignored?

Answer 26

They can quickly become major symptoms ## Footnote Vigilance is necessary to prevent worsening of the condition.

Question 27

What should be followed unless changes are recommended by a Diving Medical Officer?

Answer 27

Follow the selected treatment table ## Footnote Adherence to the recommended protocol is vital for patient safety.

Question 28

How should multiple symptoms be treated?

Answer 28

Treat for the most serious condition ## Footnote Prioritization of treatment is critical in emergency situations.

Question 29

Which is more effective: oxygen treatment tables or air treatment tables?

Answer 29

Oxygen treatment tables are significantly more effective ## Footnote Air treatment tables should only be used in specific circumstances.

Question 30

When should air treatment tables be used?

Answer 30

* After oxygen system failure * intolerable patient oxygen toxicity problems with DMO recommendation

Question 31

What is the descent rate for oxygen treatment tables?

Answer 31

20 feet per minute ## Footnote This rate is standard across the specified treatment tables.

Question 32

What depth should patients be placed on oxygen during treatment?

Answer 32

At a treatment depth of 60 fsw or shallower ## Footnote Oxygen administration at depths greater than 60 fsw make the patients prone to O2 toxicity.

Question 33

What should be used if treatment depths are deeper than 60 fsw?

Answer 33

Use treatment gas if available ## Footnote Ensures adherence to treatment protocols under varying conditions.

Question 34

When are air treatment tables IA, 2A, and 3 used?

Answer 34

Only as a last resort when oxygen is not available ## Footnote These tables are less effective and should only be employed when necessary.

Question 35

Which air treatment table should be used if pain only is relieved at a depth less than 66 feet?

Answer 35

Use Air Treatment Table IA ## Footnote This ensures the most effective treatment based on symptom relief.

Question 36

What air table should be used if pain only is relieved at a depth greater than 66 feet?

Answer 36

Use Treatment Table 2A ## Footnote This protocol is crucial for managing symptoms effectively.

Question 37

What type of symptoms is Treatment Table 3 used for?

Answer 37

Serious symptoms where oxygen cannot be used ## Footnote This table is reserved for critical conditions requiring immediate attention.

Question 38

What are the primary objectives of recompression treatment?

Answer 38

* 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 ## Footnote These objectives are essential for effective treatment of diving disorders.

Question 39

What happens if seemingly minor symptoms are ignored?

Answer 39

They can quickly become major symptoms ## Footnote Vigilance is necessary to prevent worsening of the condition.

Question 40

What should be followed unless changes are recommended by a Diving Medical Officer?

Answer 40

Follow the selected treatment table ## Footnote Adherence to the recommended protocol is vital for patient safety.

Question 41

How should multiple symptoms be treated?

Answer 41

Treat for the most serious condition ## Footnote Prioritization of treatment is critical in emergency situations.

Question 42

Which is more effective: oxygen treatment tables or air treatment tables?

Answer 42

Oxygen treatment tables are significantly more effective ## Footnote Air treatment tables should only be used in specific circumstances.

Question 43

When should air treatment tables be used?

Answer 43

After oxygen system failure or intolerable patient oxygen toxicity problems with DMO recommendation ## Footnote This ensures patient safety and optimal treatment outcomes.

Question 44

What is the descent rate for oxygen treatment tables?

Answer 44

20 feet per minute ## Footnote This rate is standard across the specified treatment tables.

Question 45

What depth should patients be placed on oxygen during treatment?

Answer 45

At a treatment depth of 60 fsw or shallower ## Footnote Proper depth management is essential for effective oxygen delivery.

Question 46

What should be used if treatment depths are deeper than 60 fsw?

Answer 46

Use treatment gas if available ## Footnote Ensures adherence to treatment protocols under varying conditions.

Question 47

When are air treatment tables IA, 2A, and 3 used?

Answer 47

Only as a last resort when oxygen is not available ## Footnote These tables are less effective and should only be employed when necessary.

Question 48

Which air treatment table should be used if pain is relieved at a depth less than 66 feet?

Answer 48

Use Air Treatment Table IA ## Footnote This ensures the most effective treatment based on symptom relief.

Question 49

What air table should be used if pain is relieved at a depth greater than 66 feet?

Answer 49

Use Treatment Table 2A ## Footnote This protocol is crucial for managing symptoms effectively.

Question 50

What type of symptoms is Treatment Table 3 used for?

Answer 50

Serious symptoms where oxygen cannot be used ## Footnote This table is reserved for critical conditions requiring immediate attention.

Question 51

What should be done if the patient with suspected DCS or AGE does not improve within 30 minutes at 165 feet?

Answer 51

Use Treatment Table 4

Question 52

During transport to a recompression chamber, how should the patient be positioned?

Answer 52

Supine (lying horizontally)

Question 53

True or False: The patient should be transported head-down.

Answer 53

False

Question 54

What should be done if symptoms improve after breathing 100 percent oxygen?

Answer 54

The patient should still be recompressed as if the original symptoms were still present

Question 55

If the patient cannot tolerate oral fluids, what should be done?

Answer 55

Insert an IV and start intravenous fluids

Question 56

What are the potential risks of transporting a patient at higher altitudes?

Answer 56

Additional reduction in external pressure causing possible increase of symptom severity or complications

Question 57

What type of aircraft should be used if available for transport?

Answer 57

Pressurized aircraft to one atmosphere

Question 58

What should be done to ensure the recompression chamber is ready for the patient?

Answer 58

Call ahead to ensure readiness and qualified medical personnel on standby

Question 59

What should be used for transport if available, in case of an emergency evacuation?

Answer 59

Emergency Evacuation Hyperbaric Stretcher

Question 60

What is the first step in recompression treatment when no recompression chamber is immediately available (require transportation)?

Answer 60

Administer 100% oxygen during transport, if available

Question 61

What should be monitored continuously during patient transport?

Answer 61

Signs of obstructed airway, cessation of breathing, cardiac arrest, or shock

Question 62

What should the patient breathe during transport if available?

Answer 62

100 percent oxygen

Question 63

If the patient is alert and able to tolerate fluids, how should hydration be administered?

Answer 63

By mouth

Question 64

What arrangements should be made in advance of diving operations?

Answer 64

Notify the recompression chamber and determine effective transportation means

Question 65

What is the recommended altitude for transporting a patient by unpressurized aircraft?

Answer 65

Less than 1,000 feet

Question 66

TRUE / FALSE Always keep in mind that multiple conditions may exist at the same time, for example, the victim may be suffering from both DCS and hypothermia.

Answer 66

TRUE

Question 67

What is the primary responsibility of the Diving Officer?

Answer 67

Complying with reporting requirements and additional duties as defined in the command dive bill. ## Footnote The Diving Officer reports to the Commanding Officer.

Question 68

Who is responsible for supervising recompression treatments?

Answer 68

The Master Diver is the most qualified person for this role.

Question 69

When can the Chamber Supervisor determine that recompression is not necessary?

Answer 69

When postdive symptoms are due to causes other than decompression sickness or arterial gas embolism, such as injury or poorly fitting equipment. ## Footnote The Chamber Supervisor must firmly establish the cause before ruling out recompression.

Question 70

List the responsibilities of the Chamber Supervisor.

Answer 70

* Adhering to minimum manning levels for treatment * Ensuring familiarity with recompression procedures * Contacting a Diving Medical Officer * Documenting patient assessment and treatment details * Tracking bottom time and decompression profiles * Communicating with personnel inside the chamber * Log decompression profiles of persons in the chamber log

Question 71

True or False: The Chamber Supervisor is responsible for ensuring every member of the chamber team is familiar with all recompression procedures.

Answer 71

True. ## Footnote Familiarity with procedures is essential for effective treatment.

Question 72

What documentation is the Chamber Supervisor responsible for during treatment?

Answer 72

Details related to the assessment and treatment of the patient, including condition prior to treatment and vital signs. ## Footnote Documentation must be in accordance with section 5-5 and the command dive bill.

Question 73

What is the role of the Diving Medical Officer in relation to medications?

Answer 73

Prescribes medications and treatment adjuncts. ## Footnote This role is essential for managing diving-related injuries effectively.

Question 74

What is the role of the DMO during recompression treatment?

Answer 74

* Recommends proper course of treatment * Consults with other medical personnel * Prescribe medications and treatment adjuncts * Can modify treatment tables with concurrence of CO/OIC ## Footnote The DMO typically locks in and out of the chamber as the patient's condition dictates and does not commit to the entire treatment unless necessary. The DMO's effectiveness in directing treatment diminishes once committed to the chamber.

Question 75

Can recompression treatment for diving-related disorders be initiated without consulting a DMO?

Answer 75

Yes, it may be initiated without consulting a DMO, but a DMO should be consulted as early as possible. ## Footnote Consultation is especially important before committing a patient to Treatment Table 4 or 7.

Question 76

What should be done in cases of decompression sickness or arterial gas embolism that do not show substantial improvement?

Answer 76

Additional medical expertise should be sought immediately. ## Footnote Deviation from standard protocols should only be made with the recommendation of a Diving Medical Officer.

Question 77

What are the subspecialty codes for a DMO?

Answer 77

* 16U0 (Basic Undersea Medical Officer) * 16U1 (Residency in Undersea Medicine trained Undersea Medical Officer).

Question 78

Who must be present inside the chamber during recompression treatment?

Answer 78

At least one qualified tender must be inside the chamber at all times. ## Footnote The inside tender should ideally be a Diving Medical Technician (DMT).

Question 79

What is the training focus of Diving Medical Technicians (DMTs)?

Answer 79

DMTs receive special training in hyperbaric medicine and medical care. ## Footnote They operate under the medical license and supervision of a DMO.

Question 80

Fill in the blank: Only DMOs with subspecialty codes 16U0 or 16U1 may ________ the treatment protocols.

Answer 80

modify

Question 81

True or False: Other physicians may modify recompression procedures.

Answer 81

False

Question 82

What must a diver candidate do to meet Navy standards?

Answer 82

* Complete a diving physical exam * conform to Navy physical standards * pass the diver candidate pressure test

Question 83

What is the primary responsibility of the inside tender during treatment?

Answer 83

Monitor the patient periodically for signs of relief of symptoms.

Question 84

How is the patient's illness diagnosed during treatment?

Answer 84

Through observation and performance of repeat neurological exams.

Question 85

What factors help determine which treatment table is used?

Answer 85

The depth and time of the patient's relief.

Question 86

List responsibilities of the inside tender.

Answer 86

* Releasing the door latches (dogs) after a seal is made * Ensure the patient is lying down and positioned to permit free blood circulation to all extremities * Ensure ear protection are worn * Communicate with outside personnel * Provide first aid as required * Monitoring the patient's vital signs * Administering treatment gas to the patient at treatment depth * Monitor the patient for signs of oxygen toxicity

Question 87

True or False: The inside tender is responsible for ensuring sound attenuators for ear protection are worn during recompression treatments.

Answer 87

True.

Question 88

What is the role of the outside tender?

Answer 88

Preparing the chamber system for use and securing it according to operating procedures.

Question 89

What is arterial gas embolism?

Answer 89

Arterial gas embolism is caused by entry of gas bubbles into the arterial circulation as a result of pulmonary over inflation syndrome (POIS) ## Footnote It can occur during any dive where compressed gas is breathed under pressure.

Question 90

When do symptoms of arterial gas embolism typically occur?

Answer 90

Symptoms usually occur suddenly and dramatically, often within minutes after arrival on the surface or even before reaching the surface.

Question 91

How long should divers be observed after surfacing from a dive with compressed gas?

Answer 91

Divers shall remain under direct observation of the Dive Supervisor for 10 minutes after surfacing.

Question 92

What can arterial gas embolism lead to if not treated appropriately?

Answer 92

It may result in death or permanent neurological damage.

Question 93

What is a basic rule for diagnosing arterial gas embolism in divers?

Answer 93

Any diver who surfaces unconscious, loses consciousness, or has obvious neurological symptoms within 10 minutes of reaching the surface must be assumed to be suffering from arterial gas embolism.

Question 94

What should be prioritized if a diver is pulseless and not breathing?

Answer 94

Establishment of airway, breathing, and circulation (ABCs) is a higher priority than recompression.

Question 95

What evaluation should a diver who surfaces unconscious and recovers when exposed to fresh air receive?

Answer 95

They shall receive a neurological evaluation to rule out arterial gas embolism.

Question 96

What should be done for victims of near-drowning incidents with no neurological symptoms?

Answer 96

They should always be carefully evaluated by a DMO for pulmonary aspiration or referred to a higher level of medical care.

Question 97

Why might a chilled diver not recognize symptoms of arterial gas embolism?

Answer 97

They may not be concerned with numbness in an arm, which may actually be a sign of CNS involvement.

Question 98

If pain is the only symptom, what conditions should be considered instead of arterial gas embolism?

Answer 98

* Decompression sickness * other pulmonary overinflation syndromes * trauma should be considered. ## footnote Paragraph 17-3.1

Question 99

What are some symptoms of Arterial Gas Embolism (AGE)?

Answer 99

Symptoms may include: * Bloody sputum * Loss of control of bodily functions * Convulsions * Tremors * Personality changes * Extreme fatigue * Altered consciousness * Difficulty in thinking * Loss of coordination * Dizziness * Vertigo * Nausea and/or vomiting * Vision abnormalities * Hearing abnormalities * Paralysis or weakness in extremities * Paresthesias * Numbness ## Footnote Additional symptoms may include signs of subcutaneous or mediastinal emphysema, pneumothorax, and/or pneumopericardium.

Question 100

What is the initial treatment for Arterial Gas Embolism (AGE)?

Answer 100

* Initial treatment involves compression to 60 fsw. * If symptoms improve, treatment continues using Treatment Table 6. * If symptoms remain unchanged or worsen, assess the patient upon descent and compress to depth of relief, not to exceed 165 fsw. ## Footnote Follow the guidelines in Figure 17-1 for treatment protocol.

Question 101

What should be done for a diver experiencing cardiopulmonary arrest?

Answer 101

Immediate CPR and application of an Automated External Defibrillator (AED) are indicated for a diver with no pulse or respirations. ## Footnote Access to advanced cardiac life support (ACLS) is a higher priority than recompression. ACLS requires special medical training and equipment, which may not always be available.

Question 102

True or False: Electrical therapy such as defibrillation must be performed at depth.

Answer 102

False ## Footnote Electrical therapy must be performed on the surface.

Question 103

Fill in the blank: If symptoms of AGE improve during the first oxygen breathing period, treatment is continued using _______.

Answer 103

Treatment Table 6 ## Footnote This table provides specific treatment protocols for various conditions.

Question 104

What are some signs that a diver may experience during ascent related to AGE?

Answer 104

Signs may include: * Sensation similar to a blow to the chest * Unconsciousness without warning * Stopping breathing ## Footnote These signs indicate serious complications and require immediate attention.

Question 105

What may accompany symptoms of Arterial Gas Embolism?

Answer 105

Symptoms of: * subcutaneous or mediastinal emphysema * pneumothorax * pneumopericardium ## Footnote These associated conditions should not be overlooked in cases of AGE.

Question 106

What is the recommended action if a diver's symptoms do not improve during treatment at 60 fsw?

Answer 106

Assess the patient upon descent and compress to depth of relief, not to exceed 165 fsw.

Question 107

What is the purpose of an Automated External Defibrillator (AED) in diving emergencies?

Answer 107

An AED can deliver life-saving shocks when a shockable heart rhythm is detected. ## Footnote While it is not a substitute for the full range of interventions of ACLS, it is critical in emergencies.

Question 108

What does 'ACLS' stand for?

Answer 108

Advanced Cardiac Life Support ## Footnote ACLS requires special medical training and equipment.

Question 109

What must begin immediately for a pulseless diver?

Answer 109

CPR must begin immediately ## Footnote An AED should also be placed on the victim as soon as possible.

Question 110

What should be done while transporting a patient to medical care?

Answer 110

Continue basic life support (BLS) measures ## Footnote All efforts should be made to transport the patient to the highest level of medical care available.

Question 111

What is the most viable treatment for drowning victims?

Answer 111

Effective rescue breathing, excellent chest compressions, and immediate evacuation ## Footnote Delays in access to a critical care facility can result in an unfavorable outcome.

Question 112

Is defibrillation authorized at depth?

Answer 112

No ## Footnote CAUTION: Defibrillation is not currently authorized at depth.

Question 113

What should be avoided if a pulseless diver does not regain vital signs after AED application?

Answer 113

Avoid recompressing the pulseless diver ## Footnote Continue resuscitation efforts until recovery or pronouncement of death.

Question 114

What is necessary for the diagnosis of decompression sickness?

Answer 114

A history of diving (or altitude exposure) ## Footnote Depth and duration of the dive help establish missed decompression requirements.

Question 115

Can decompression sickness occur within no-decompression limits?

Answer 115

Yes ## Footnote It can also occur in divers who have followed decompression tables carefully.

Question 116

How are symptoms of decompression sickness categorized?

Answer 116

Type I and Type II ## Footnote Treatment may differ based on the type.

Question 117

What must be done for any decompression sickness that occurs?

Answer 117

It must be treated by recompression ## Footnote Distinguishing between Type I and Type II symptoms is important for treatment.

Question 118

What is a common symptom of decompression sickness?

Answer 118

Joint pain and musculoskeletal symptoms ## Footnote Symptoms may vary in intensity and localization.

Question 119

When do symptoms of decompression sickness typically occur after a dive?

Answer 119

Symptoms usually occur shortly following the dive ## Footnote The onset can vary significantly based on the dive profile.

Question 120

What percentage of symptoms occur within 1 hour after surfacing?

Answer 120

42 percent ## Footnote This statistic is based on a database of air dives analyzed by the U.S. Navy.

Question 121

What percentage of decompression sickness symptoms occur within 3 hours?

Answer 121

60 percent ## Footnote Early recognition of symptoms can be crucial for treatment.

Question 122

What percentage of symptoms occur within 8 hours after surfacing?

Answer 122

83 percent ## Footnote Symptoms can develop at various times, making monitoring essential.

Question 123

What is the hallmark of Type I decompression sickness pain?

Answer 123

Dull, aching quality confined to particular areas ## Footnote It is always present at rest and usually unaffected by movement.

Question 124

What are typical sites of joint pain in Type I decompression sickness?

Answer 124

Shoulder, elbow, wrist, hand, knee, and ankle ## Footnote Pain may also occur in muscles and may not be joint-related.

Question 125

What symptoms indicate possible spinal cord involvement in decompression sickness?

Answer 125

* Pain localized to joints between the ribs and spinal column or ribs and sternum * radicular / girdle pain * a vague aching pain in the chest or abdomen ## Footnote Such symptoms should be treated as Type II decompression sickness.

Question 126

Fill in the blank: The most common symptom of decompression sickness is _______.

Answer 126

joint pain ## Footnote Joint pain is often the first sign of decompression sickness.

Question 127

True or False: All symptoms of decompression sickness are pronounced and easily identifiable.

Answer 127

False ## Footnote Some symptoms can be subtle and easily overlooked.

Question 128

Who must be present in the chamber at all times during treatment?

Answer 128

A qualified tender

Question 129

What should be done at the depth of relief or treatment depth?

Answer 129

* Assess symptoms * Administer treatment gas * Neuro Exam * Vitals

Question 130

When should air treatment tables be used?

Answer 130

Only if oxygen is unavailable

Question 131

What should be monitored when oxygen is used?

Answer 131

Warning signs of oxygen toxicity

Question 132

What should be done in the event of an oxygen convulsion?

Answer 132

Remove the oxygen mask and keep the patient from self-harm. ## footnote Do not force the mouth open.

Question 133

What limitations must be maintained regarding oxygen usage?

Answer 133

Time and depth limitations prescribed by the treatment table

Question 134

How often should the patient's condition and vital signs be checked?

Answer 134

Periodically Frequently if the condition is changing rapidly or vital signs are unstable

Question 135

For how long should a patient remain at the recompression facility for observation after treatment for symptoms?

Answer 135

2 hours for TT5 6 hours for type II DCS or were treated with a TT6 ##footnote Do not release patient without consulting a DMO

Question 136

What should be done before releasing a patient?

Answer 136

Consult a Diving Medical Officer

Question 137

What must never be permitted regarding the treatment tables?

Answer 137

Modifications ## footnote Except under the direction of a Diving Medical Officer

Question 138

What should be done if breathing ceases?

Answer 138

Use mouth-to-mouth resuscitation with a barrier device immediately

Question 139

How long should chest compressions not be interrupted?

Answer 139

Longer than 10 seconds

Question 140

What is prohibited regarding the use of 100 percent oxygen?

Answer 140

Never use O2 deeper than 60 fsw

Question 141

What position should personnel in the chamber avoid?

Answer 141

A cramped position that might interfere with complete blood circulation

Question 142

What type of pain is described as vague and aching in the chest or abdomen?

Answer 142

Visceral pain

Question 143

What is the most difficult differentiation in decompression sickness?

Answer 143

Between Type I decompression sickness pain and pain from trauma or other injury

Question 144

What should be assumed if there is any doubt about the cause of the pain in a dive related casualty?

Answer 144

Assume the diver is suffering from decompression sickness and treat accordingly

Question 145

What DCS type I symptoms indicate spinal cord involvement?

Answer 145

* Pain localized to joints between the ribs and spinal column or joints between the ribs and sternum * Radicular / Girdle pain: A shooting type pain that radiates from the back around the pain. * Visceral pain: a vague aching pain in chest or abdomen ## footnote Treat as type II DCS

Question 146

What are the “always” and “never” rules for decompression treatment. Table 17-2

Answer 146

Question 147

What is the most common cutaneous (skin) manifestation of decompression sickness?

Answer 147

Itching ## Footnote Itching is generally transient and does not require recompression. Mottling / marbling of the skin (cutis marmorata may precede symptoms of serious DCS and should be treated as type II DCS

Question 148

What skin condition may precede serious decompression sickness?

Answer 148

Cutis marmorata (marbling) ## Footnote Treat as type II DCS

Question 149

What symptoms may indicate lymphatic obstruction in decompression sickness?

Answer 149

Localized pain in lymph nodes and tissue swelling ## Footnote Recompression may provide prompt relief from pain.

Question 150

How should Type I Decompression Sickness be treated?

Answer 150

In accordance with Figure 17-2 ## Footnote If a full neurological exam is not completed before initial recompression, treat as Type II DCS.

Question 151

What may indicate orthopedic injury rather than decompression sickness?

Answer 151

Musculoskeletal pain with no change after the second oxygen breathing period at 60 feet ## Footnote Review patient's history for specific orthopedic trauma.

Question 152

What are the early symptoms of Type II Decompression Sickness?

Answer 152

Fatigue and weakness ## Footnote Divers may attribute these symptoms to overexertion.

Question 153

What are the three categories of serious symptoms in Type II Decompression Sickness?

Answer 153

* Neurological * inner ear (staggers) * cardiopulmonary (chokes) ## Footnote Type I symptoms may or may not be present simultaneously.

Question 154

What are common neurological symptoms of Type II Decompression Sickness?

Answer 154

* Numbness * paresthesias * decreased sensation to touch * muscle weakness * paralysis * mental status changes ## Footnote Disturbances can also include personality changes and lack of coordination.

Question 155

True or False: Initial denial of DCS is uncommon.

Answer 155

False ## Footnote Initial denial of DCS is common, requiring recognition of symptoms during the post-dive period.

Question 156

True or False: Symptoms of Type II decompression sickness may not be obvious and the diver may consider them inconsequential

Answer 156

True ## Footnote This can delay treatment until symptoms become severe.

Question 157

What are common symptoms of inner ear decompression sickness?

Answer 157

* Tinnitus (ringing in the ears) * Hearing loss * Vertigo * Dizziness * Nausea * Vomiting ## Footnote Inner ear decompression sickness often occurs in helium-oxygen diving

Question 158

What is another name for inner ear decompression sickness?

Answer 158

"The Staggers" ## Footnote This term refers to the difficulty in walking due to vestibular system dysfunction

Question 159

What symptoms may indicate the presence of chokes in a diver?

Answer 159

* Chest pain aggravated by inspiration * Irritating cough * Increased breathing rate ## Footnote Profuse intravascular bubbling can lead to these symptoms

Question 160

What can happen if symptoms of chokes progress without recompression?

Answer 160

Complete circulatory collapse, loss of consciousness, and death ## Footnote Immediate recompression is critical to prevent severe outcomes

Question 161

What is the main differentiating factor between Type II DCS and arterial gas embolism?

Answer 161

Time course of symptoms ## Footnote AGE usually occurs within 10 minutes of surfacing

Question 162

What is the initial treatment for Type II Decompression Sickness?

Answer 162

Compression to 60 fsw ## Footnote Treatment continues based on symptom improvement

Question 163

What should be done if severe symptoms of Type II DCS do not improve within the first 20 minutes at 60 fsw?

Answer 163

Assess the patient during descent and compress to a depth of relief, not exceeding 165 fsw ## Footnote Treatment should then follow Treatment Table 6A

Question 164

What is the predominant symptom of decompression sickness that may develop in the water?

Answer 164

Joint pain ## Footnote More serious manifestations may include numbness, weakness, hearing loss, and vertigo.

Question 165

When is decompression sickness most likely to appear during a dive?

Answer 165

At the shallow decompression stops just prior to surfacing ## Footnote Some cases may occur during ascent to the first stop or shortly thereafter.

Question 166

What should be done if a diver has had an uncontrolled ascent and exhibits symptoms?

Answer 166

Compress immediately in a recompression chamber to 60 fsw ## Footnote Conduct a rapid assessment of the patient and treat accordingly.

Question 167

What treatment should be started if a diver surfaced from 50 fsw or shallower with symptoms?

Answer 167

Compress to 60 fsw and begin Treatment Table 6 ## Footnote Treatment Table 5 is not appropriate for symptomatic omitted decompression.

Question 168

What is the maximum depth for compression if symptoms are significantly improved but not exceeding what depth?

Answer 168

165 fsw ## Footnote For uncontrolled ascent deeper than 165 feet, Treatment Table 8 may be used at the depth of relief, not to exceed 225 fsw.

Question 169

What is the protocol when no recompression chamber is available for symptomatic divers?

Answer 169

Immediate transportation to a recompression facility while receiving 100% surface oxygen ## Footnote Guidelines in paragraph 17-5.4 may be useful if transportation is impossible.

Question 170

What is altitude decompression sickness?

Answer 170

Decompression sickness occurring with exposure to subatmospheric pressures ## Footnote Symptoms may be similar to those experienced by divers but with less spinal cord involvement.

Question 171

What treatment is indicated if only joint pain was present but resolved before reaching one ata from altitude?

Answer 171

Two hours of 100 percent oxygen breathing at the surface followed by 24 hours of observation ## Footnote This is applicable when joint pain resolves before reaching one ata.

Question 172

What should be done for other symptoms or if joint pain persists after returning to one ata?

Answer 172

Transfer to a recompression facility and treat on the appropriate treatment table ## Footnote Individuals should be kept on 100 percent oxygen during transfer.

Question 173

What are the primary objectives of recompression treatment?

Answer 173

* Compress gas bubbles to a small volume * Allow sufficient time for bubble resorption * Increase blood oxygen content and oxygen delivery to injured tissues ## Footnote These objectives are crucial for effective treatment of diving disorders.

Question 174

What is the importance of prompt treatment in recompression therapy?

Answer 174

The effectiveness of treatment decreases as the length of time between the onset of symptoms and the treatment increases ## Footnote Prompt treatment is critical to ensure the best outcomes.

Question 175

True or False: Minor symptoms should be ignored in recompression treatment.

Answer 175

False ## Footnote Seemingly minor symptoms can quickly escalate to major symptoms.

Question 176

What should be followed unless changes are recommended by a Diving Medical Officer?

Answer 176

The selected treatment table ## Footnote Adhering to the treatment table ensures standardization and safety.

Question 177

In case of multiple symptoms during a diving disorder, which condition should be treated first?

Answer 177

The most serious condition ## Footnote Prioritizing serious conditions helps in managing critical situations effectively.

Question 178

What type of treatment tables are significantly more effective than air treatment tables?

Answer 178

Oxygen treatment tables ## Footnote Oxygen treatment is preferred whenever available.

Question 179

When should Air Treatment Tables be used?

Answer 179

Only as a last resort when oxygen is not available ## Footnote Air treatment tables are less effective and should be secondary to oxygen treatment.

Question 180

What is the descent rate for treatment using Oxygen Treatment Tables?

Answer 180

20 feet per minute ## Footnote This descent rate is standard for all specified treatment tables.

Question 181

At what treatment depth should a patient be placed on oxygen?

Answer 181

60 fsw or shallower ## Footnote This depth is critical for maximizing the benefits of oxygen therapy.

Question 182

What air treatment table should be used if pain is relieved at a depth less than 66 feet?

Answer 182

Air Treatment Table 1A ## Footnote This table is specifically designed for cases where pain is manageable at shallower depths.

Question 183

What air treatment table should be used if pain is relieved at a depth greater than 66 feet?

Answer 183

Treatment Table 2A ## Footnote This table is for deeper treatments where pain persists.

Question 184

What is Treatment Table 3 used for?

Answer 184

Treatment of serious symptoms where oxygen cannot be used ## Footnote This table is a critical backup for severe cases without oxygen availability.

Question 185

What should be administered to a patient with suspected DCS or AGE during transport?

Answer 185

100% oxygen ## Footnote This is crucial if available to manage symptoms effectively.

Question 186

What position should the patient be kept in while being transported to a recompression chamber?

Answer 186

Supine (lying horizontally) ## Footnote The patient must not be put head-down.

Question 187

What should be continuously monitored during the transport of a patient?

Answer 187

Signs of obstructed airway, cessation of breathing, cardiac arrest, or shock ## Footnote These are critical conditions that may arise during transport.

Question 188

What should be done if symptoms of decompression sickness improve during transport?

Answer 188

Recompress the patient as if the original symptoms were still present ## Footnote This ensures proper treatment despite symptom relief.

Question 189

What hydration measures should be taken for the patient during transport?

Answer 189

Give fluids by mouth if alert or insert IV for intravenous fluids ## Footnote Adequate hydration is essential for the patient's condition.

Question 190

What altitude should unpressurized aircraft fly at when transporting a patient?

Answer 190

Less than 1,000 feet ## Footnote This minimizes additional pressure reduction and potential symptom severity.

Question 191

What should be done prior to transporting a patient to a recompression chamber?

Answer 191

Call ahead to ensure the chamber will be ready and qualified personnel are on standby ## Footnote This preparation is vital for effective treatment upon arrival.

Question 192

What is the recommended transport method if the patient must be moved by unpressurized aircraft?

Answer 192

Use the Emergency Evacuation Hyperbaric Stretcher if available ## Footnote This allows for safer transport under critical conditions.

Question 193

Fill in the blank: If symptoms are not relieved in less than 30 minutes at 165 feet, use _______.

Answer 193

Treatment Table 4 ## Footnote This refers to a specific protocol for treatment.

Question 194

What should be considered an option of last resort in recompression?

Answer 194

In-Water Recompression ## Footnote Used only when no recompression facility is on site and symptoms are significant.

Question 195

Under what circumstances can an uncertified chamber be used in recompression?

Answer 195

Only in emergencies and it is deemed safe by a qualified Chamber Supervisor

Question 196

What are severe Type II symptoms that indicate risk during in-water recompression?

Answer 196

Unconsciousness, paralysis, vertigo, respiratory distress, shock ## Footnote These symptoms suggest increased harm outweighs benefits of in-water recompression.

Question 197

What should be done if a diver is experiencing severe symptoms?

Answer 197

Keep them at the surface on 100% oxygen and evacuate to a recompression facility ## Footnote Regardless of any delays.

Question 198

How long should a diver breathe 100% oxygen before considering in-water recompression?

Answer 198

30 minutes ## Footnote If symptoms stabilize or improve, do not attempt in-water recompression unless symptoms reappear.

Question 199

What is the maximum time a patient should continue breathing 100% oxygen?

Answer 199

12 hours ## Footnote Air breaks may be given as necessary.

Question 200

What should be done if: * surface oxygen proves ineffective after 30 minutes * no decompression facility on site * no prospect of reaching a decompression facility within a reasonable timeframe (12-24 hours)

Answer 200

Begin in-water recompression ## Footnote Hypothermia risk must also be considered.

Question 201

Which is preferable for in-water recompression: using air or oxygen?

Answer 201

Using oxygen ## Footnote In-water recompression using air is always less preferable.

Question 202

What should be followed as closely as possible during in-water recompression using air?

Answer 202

Air Treatment Table 1A ## Footnote Specific guidelines for treatment.

Question 203

What type of breathing apparatus is preferred for in-water recompression?

Answer 203

Surface-supplied helmet UBA ## Footnote Full face mask is also acceptable.

Question 204

What should never be used for in-water recompression unless it is the only option?

Answer 204

SCUBA with a mouthpiece ## Footnote This is a last resort option.

Question 205

What must be maintained during the in-water recompression process?

Answer 205

Constant communication ## Footnote Essential for safety and coordination.

Question 206

How many divers should be with the patient at all times during in-water recompression?

Answer 206

At least one diver ## Footnote Ensures safety and monitoring.

Question 207

What should be planned carefully during in-water recompression?

Answer 207

Shifting UBAs or cylinders ## Footnote Important for effective treatment.

Question 208

What is required in terms of manpower for in-water recompression?

Answer 208

An ample number of tenders topside ## Footnote Ensures support and safety.

Question 209

If the depth is too shallow for in water decompression treatment according to treatment table 1a, what should be done?

Answer 209

* Recompress the patient to the maximum available depth * Then remain at that depth for 30 minutes. ## Footnote Decompress according to TT1a Do not use stops shorter than those of TT1a

Question 210

What should be done first if 100 percent oxygen is available to the diver using an oxygen rebreather?

Answer 210

Put the stricken diver on the UBA and have the diver purge the apparatus at least three times with oxygen.

Question 211

How long should a diver remain at 30 feet for Type I symptoms during in-water recompression using oxygen?

Answer 211

60 minutes

Question 212

What is the recommended duration for in water recompression using oxygen at 30 feet for Type II symptoms?

Answer 212

90 minutes

Question 213

What is the next step after remaining at 30 feet during in-water recompression using oxygen?

Answer 213

Ascend to 20 feet even if symptoms are still present.

Question 214

What is the protocol for decompression after reaching 20 feet when conducting in water recompression using oxygen?

Answer 214

Take 60-minute stops at 20 feet and 10 feet.

Question 215

How long should a diver continue breathing 100 percent oxygen after surfacing from an in water recompression using oxygen?

Answer 215

An additional 3 hours

Question 216

What should be done if symptoms persist or recur on the surface after completing in water recompression using oxygen?

Answer 216

Arrange for transport to a recompression facility regardless of the delay.

Question 217

What does the occurrence of Type II symptoms after in-water recompression indicate?

Answer 217

It is an ominous sign and could progress to severe, debilitating decompression sickness.

Question 218

What dictates the speed of evacuation to a recompression facility?

Answer 218

Operational considerations and remoteness of the dive site

Question 219

When should Air Treatment Tables be used?

Answer 219

Only as a last resort when oxygen is not available.

Question 220

What can Treatment Table 5 be used for?

Answer 220

* Type I DCS (except for cutis marmorata) symptoms with no other abnormality * Asymptomatic omitted decompression * Treatment of resolved symptoms following in-water recompression * Follow-up treatments for residual symptoms * Carbon monoxide poisoning * Gas gangrene

Question 221

What should be performed after arrival at 60 fsw according to Treatment Table 5?

Answer 221

A neurological exam to ensure no overt neurological symptoms are present. ## footnote If abnormalities are found, the stricken diver should be treated using TT6

Question 222

What are the steps for in water recompression using oxygen? 17-5.4.2.2

Answer 222

Question 223

What is Treatment Table 6 used for?

Answer 223

* Arterial gas embolism * Type II DCS symptoms * Type I DCS symptoms where relief is not complete within 10 minutes at 60 feet * Cutis marmorata * Severe carbon monoxide poisoning * Cyanide poisoning * Smoke inhalation * Asymptomatic omitted decompression * Symptomatic uncontrolled ascent * Recurrence of symptoms shallower than 60 fsw ## Footnote Treatment Table 6 is essential for addressing various decompression and gas-related emergencies in diving medicine.

Question 224

When is Treatment Table 6A used?

Answer 224

When severe symptoms remain unchanged or worsen within the first 20 minutes at 60 fsw ## Footnote Treatment Table 6A is specifically designed for cases where immediate intervention is required for worsening conditions.

Question 225

What should be done once at the depth of relief using Treatment Table 6A?

Answer 225

Begin treatment gas (N2, HeO2) if available. Consult with DMO at earliest opportunity

Question 226

What is the maximum depth for Treatment Table 6A?

Answer 226

165 fsw ## Footnote This depth limit is crucial to ensure patient safety and effective treatment.

Question 227

What is the protocol if deterioration or recurrence of symptoms occurs during ascent to 60 feet?

Answer 227

Treat as a recurrence of symptoms ## Footnote Figure 17-3 treatment of symptom recurrence.

Question 228

When is Treatment Table 4 used?

Answer 228

When a patient would receive additional benefit at depth of significant relief, not to exceed 165 fsw ## Footnote Treatment Table 4 provides further intervention for patients who do not respond adequately to initial treatments.

Question 229

What is the recommended duration for oxygen breathing periods upon arrival at the 60-foot stop on a TT4?

Answer 229

25 minutes on oxygen, interrupted by 5 minutes of air ## Footnote For a total time of 2 hours

Question 230

What should both the patient and tender do regarding oxygen breathing before ascent from 30 feet?

Answer 230

Breathe oxygen for at least 4 hours, beginning no later than 2 hours before ascent to 30 fsw ## Footnote Eight: [25 minute oxygen, 5 minute air periods.]

Question 231

Fill in the blank: Treatment Table 6A is used for _______

Answer 231

severe symptoms that remain unchanged of worsen within the first 20 minutes at 60 fsw

Question 232

True or False: Treatment Table 4 shift from Treatment Table 6A is recommended without consulting a Diving Medical Officer.

Answer 232

False ## Footnote A Diving Medical Officer should be consulted before making the shift.

Question 233

What is the internal chamber temperature requirement before committing to Treatment Table 7?

Answer 233

85°F (29°C) or less ## Footnote This temperature must be maintained to ensure safe treatment.

Question 234

What is Treatment Table 8 adapted from?

Answer 234

Royal Navy Treatment Table 65 ## Footnote It is mainly for treating deep uncontrolled ascents when more than 60 minutes of decompression have been missed.

Question 235

What is the maximum depth for compressing a symptomatic patient using Treatment Table 8?

Answer 235

225 fsw ## Footnote This depth should not be exceeded during treatment.

Question 236

What does Treatment Table 9 provide?

Answer 236

90 minutes of oxygen breathing at 45 feet ## Footnote This treatment is specific and requires a Diving Medical Officer's recommendation.

Question 237

What conditions is Treatment Table 9 used for?

Answer 237

* Residual symptoms after initial treatment of AGE/DCS * Selected cases of carbon monoxide or cyanide poisoning * Smoke inhalation ## Footnote These conditions require specific medical oversight.

Question 238

What is required for using U.S. Navy recompression chambers for non-diving disorders?

Answer 238

Authorization from BUMED Code M95 ## Footnote This is necessary for treatments not listed in the standard protocols.

Question 239

What types of non-diving medical conditions can be treated with HBO therapy?

Answer 239

* Cyanide poisoning * Carbon monoxide poisoning * Gas gangrene * Smoke inhalation * Necrotizing soft-tissue infections * Arterial gas embolism from surgery ## Footnote Any treatment of non diving related conditions shall be done under the cognizant UMO

Question 240

Who must oversee the treatment of non-diving related medical conditions in a recompression chamber?

Answer 240

A UMO

Question 241

What is the source of the guidelines for conducting HBO therapy?

Answer 241

Undersea and Hyperbaric Medical Society's Hyperbaric Oxygen (HBO) Therapy Committee Report-2014 ## Footnote This report outlines the approved indications for HBO therapy.

Question 242

What does the guidelines for HBO therapy prescribe for each condition?

Answer 242

* Recommended Treatment Table * Frequency of treatment * Minimum and maximum number of treatments

Question 243

What is the minimum oxygen percentage that should not fall below during treatment schedules in a chamber atmosphere?

Answer 243

19 percent ## Footnote Oxygen can be added to maintain this level through ventilation or an oxygen breathing system.

Question 244

What is the maximum oxygen percentage permitted in a chamber?

Answer 244

25 percent ## Footnote If oxygen levels exceed this, ventilation with air is necessary.

Question 245

What should be used to determine the adequacy of ventilation and addition of oxygen in a chamber?

Answer 245

Portable oxygen analyzer ## Footnote If unavailable, follow ventilation guidelines to ensure adequate oxygenation.

Question 246

What is the maximum allowable carbon dioxide level in the chamber?

Answer 246

1.5 percent SEV (11.4 mmHg) ## Footnote This level must not be exceeded to prevent health risks.

Question 247

How should chamber carbon dioxide levels be monitored?

Answer 247

With electronic carbon dioxide monitors ## Footnote Correct readings for depth must be taken into account.

Question 248

What are the surface CO2 monitor values to maintain for various chamber depths?

Answer 248

* 0.78 percent at 30 feet * 0.53 percent at 60 feet * 0.25 percent at 165 feet ## Footnote These values help keep chamber CO2 under 1.5 percent SEV.

Question 249

When should the absorbent in a carbon dioxide scrubber be changed?

Answer 249

When CO2 reaches 1.5 percent SEV (11.4 mmHg) ## Footnote If it cannot be changed, supplemental ventilation is required.

Question 250

What should be done with expired CO2 absorbent?

Answer 250

It shall not be used in any recompression chamber ## Footnote Always check the expiration date on absorbent containers.

Question 251

What is necessary for maintaining comfortable internal chamber temperature?

Answer 251

Cooling through chamber ventilation ## Footnote A heater/chiller unit can also help maintain temperature.

Question 252

What should be done to prevent chambers from overheating?

Answer 252

Shade them from direct sunlight ## Footnote Continuous cooling is often required due to heat generation.

Question 253

What should be checked in Table 17-5 regarding chamber occupants?

Answer 253

Maximum durations for chamber occupants based on internal temperature ## Footnote This ensures safety and comfort during treatment.

Question 254

What is the recommended chamber temperature for treatment?

Answer 254

Below 85°F (29°C) ## Footnote A chamber temperature below 85°F is always desirable, regardless of the treatment table used.

Question 255

What should be avoided when treating victims of AGE or severe neurological DCS?

Answer 255

Hot environments that elevate body temperature above normal ## Footnote It is recommended to avoid hot environments whenever possible.

Question 256

What is the maximum tolerance time for an internal chamber temperature of over 104°F (40°C)?

Answer 256

Intolerable ## Footnote No treatments are permitted at this temperature.

Question 257

What is the maximum tolerance time for an internal chamber temperature between 95-104°F (34.4-40°C)?

Answer 257

2 hours ## Footnote This time is applicable for Treatment Tables 5 and 9.

Question 258

What is the maximum tolerance time for an internal chamber temperature between 85-94°F (29-34.4°C)?

Answer 258

6 hours ## Footnote This time applies to Treatment Tables 5, 6, 6A, 1A, and 9.

Question 259

What is the permissible exposure time for internal chamber temperatures under 85°F (29°C)?

Answer 259

Unlimited ## Footnote All treatments are permitted at this temperature.

Question 260

What methods can be used to keep the internal chamber temperature below ambient?

Answer 260

Venting or using an installed chiller unit ## Footnote These methods help maintain comfortable temperatures.

Question 261

What types of thermometers should not be used in hyperbaric chambers?

Answer 261

Mercury thermometers ## Footnote Mercury thermometers are unsafe for use around hyperbaric chambers.

Question 262

How much fluid is usually sufficient for fully conscious patients during treatment?

Answer 262

1 to 2 liters ## Footnote This can include water, juice, or non-carbonated drinks.

Question 263

How should patients with Type II symptoms or arterial gas embolism receive fluids?

Answer 263

Consider IV fluids ## Footnote These patients should be assessed for intravenous fluid needs.

Question 264

What is the recommended IV fluid drip rate for stuporous or unconscious patients?

Answer 264

75 to 100 cc/hour ## Footnote Isotonic fluids like Lactated Ringer's Solution or Normal Saline should be used.

Question 265

What solutions should be avoided if brain or spinal cord injury is present?

Answer 265

Solutions containing glucose (Dextrose) ## Footnote Glucose may worsen the outcome for such injuries.

Question 266

What should be assessed as soon as possible for patients with potential bladder paralysis?

Answer 266

The ability to void ## Footnote If the patient cannot empty a full bladder, a urinary catheter should be inserted.

Question 267

How should catheter balloons be inflated?

Answer 267

With liquid, not air ## Footnote This is important for safe catheter use.

Question 268

What indicates adequate fluid administration in patients?

Answer 268

Urine output of at least 0.5 cc/kg/hr ## Footnote Thirst is considered an unreliable indicator of hydration.

Question 269

What is a useful indicator of proper hydration?

Answer 269

Clear colorless urine ## Footnote A clear colorless urine indicates adequate hydration levels in the body.

Question 270

What is the purpose of ventilation in chambers?

Answer 270

To control oxygen level, carbon dioxide level, and temperature ## Footnote Ventilation is crucial for maintaining a safe environment in chambers, especially those without carbon dioxide scrubbers.

Question 271

What is the recommended ventilation rate for each resting occupant?

Answer 271

Two acfm ## Footnote 'acfm' stands for actual cubic feet per minute, a measurement of airflow.

Question 272

What should the ventilation rate be for each active occupant?

Answer 272

Four acfm ## Footnote Active occupants require more ventilation due to increased oxygen consumption.

Question 273

What is the maximum effective concentration of carbon dioxide allowed in the chamber?

Answer 273

1.5 percent sev (11.4 mmHg) ## Footnote This limit is set to ensure the safety of chamber occupants.

Question 274

What is the maximum percentage of oxygen allowed in the chamber when oxygen is being used?

Answer 274

25 percent ## Footnote This limit is to prevent oxygen toxicity and ensure safety.

Question 275

What is required for treatments longer than a Treatment Table 6?

Answer 275

Access to inside occupants ## Footnote TT 4, 7, and 8 requires a double lock chamber

Question 276

What type of chamber is mandatory for Treatment Tables 4, 7, or 8?

Answer 276

Double-lock chamber ## Footnote A double-lock chamber allows for controlled entry and exit of personnel.

Question 277

At what depth can all chamber occupants breathe 100 percent oxygen without locking in additional personnel?

Answer 277

45 feet or shallower ## Footnote This is a safety measure to manage oxygen exposure.

Question 278

What should tenders do with oxygen masks during treatments?

Answer 278

Hold them on their faces ## Footnote Tenders should not fasten the masks to allow for easier adjustments.

Question 279

What is the minimum surface interval between consecutive treatments on Treatment Tables 1A, 2A, 3, 5, 6, and 6A?

Answer 279

Normally At least 18 hours ## footnote 5, 6, 6A can be done sooner. All other tables must follow minimum surface intervals.

Question 280

What is the minimum surface interval for consecutive treatments on Tables 4, 7, and 8?

Answer 280

At least 48 hours ## Footnote Longer intervals are necessary due to the more intensive nature of these treatments.

Question 281

What should be done if repeating Treatment Tables 5, 6, or 6A within the 18-hour surface interval

Answer 281

oxygen is breathed at 30 fsw and shallower ## footnote Outlined in table 17-7

Question 282

What may need to be decreased during descent to allow for patient equalization?

Answer 282

Descent rates ## Footnote Equalization is crucial for patients to prevent barotrauma.

Question 283

What type of gas mixtures may be used to treat patients at depths greater than 60 fsw?

Answer 283

High oxygen, He mixtures ## Footnote These mixtures offer therapeutic advantages over air at greater depths.

Question 284

What is the recommended ppO2 range for treatment gas at the treatment depth?

Answer 284

Between 1.5 and 3.0 ata ## Footnote Table 17-6 shows gas mixes suitable over 61-225 fsw.

Question 285

What is preferred for recompression deeper than 165 fsw to avoid narcosis?

Answer 285

Helium mixtures ## Footnote Helium mixtures reduce the risk of nitrogen narcosis at greater depths.

Question 286

At what depth can high oxygen mixtures be substituted for 100% oxygen?

Answer 286

60 fsw and shallower ## Footnote This substitution occurs if the patient is unable to tolerate 100% oxygen.

Question 287

What are the gas mixtures used at different depths according to Table 17-6?

Answer 287

* 0-60 fsw: 100% * 61-165 fsw: 50/50 * 166-225 fsw: 64/36 (HeO, only) ## Footnote These mixtures correspond to specific depths and their partial pressures.

Question 288

What is the range of ppO2 for depths of 0-60 fsw?

Answer 288

1.00-2.82 ## Footnote This range corresponds to the oxygen partial pressure at that depth.

Question 289

What type of oxygen toxicity may develop during treatment?

Answer 289

CNS oxygen toxicity Pulmonary oxygen toxicity ## Footnote This can develop on any oxygen treatment table.

Question 290

When is pulmonary oxygen toxicity likely to develop?

Answer 290

May develop on Treatment Tables 4, 7, or 8, and with repeated Treatment Table 6.

Question 291

What mnemonic can help remember the early symptoms of CNS oxygen toxicity?

Answer 291

VENTID-C ## Footnote This stands for: Vision, Ears, Nausea, Twitching/Tingling, Irritability, Dizziness, Convulsions.

Question 292

Is CNS oxygen toxicity likely at chamber depths of 50 feet or shallower?

Answer 292

Unlikely ## Footnote This is especially true for resting individuals. Very unlikely shallower than 30 fsw regardless of activity level

Question 293

What should be done at the first sign of CNS oxygen toxicity?

Answer 293

Remove the patient from oxygen and allow them to breathe chamber air ## Footnote After 15 minutes with no symptoms, oxygen breathing can be resumed at the point of interruption

Question 294

What is not recommended during a convulsion associated with CNS oxygen toxicity?

Answer 294

Inserting an airway device or bite block ## Footnote This is difficult and may cause harm if attempted.

Question 295

What should be done for Treatment Tables 5, 6, and 6A if symptoms develop again?

Answer 295

* Remove the mask * after symptoms have subsided, decompress 10 fsw at 1’ per minute * resume oxygen breathing at the shallower depth at point of interruption ## Footnote If another symptom occurs after ascending, contact the UMO to recommend appropriate modifications.

Question 296

What is pulmonary oxygen toxicity?

Answer 296

Pulmonary oxygen toxicity is unlikely to develop on single Treatment Tables 5, 6, or 6A ## Footnote It can develop on Treatment Tables 4, 7, or 8 or with repeated Treatment Tables 5, 6, or 6A.

Question 297

What symptoms may indicate pulmonary oxygen toxicity during treatment?

Answer 297

End-inspiratory discomfort, substernal burning, severe pain on inspiration ## Footnote These symptoms may progress with prolonged exposure to oxygen.

Question 298

What should be done if a patient complains of substernal burning while responding well to treatment?

Answer 298

Discontinue use of oxygen and consult with a DMO ## Footnote If neurological deficit remains, oxygen breathing should continue.

Question 299

When should oxygen breathing be continued despite substernal burning?

Answer 299

If significant neurological deficit remains or if deterioration occurs upon interruption ## Footnote Oxygen should be continued until pain limits inspiration.

Question 300

What adjustments should be made if oxygen breathing must continue beyond substernal burning?

Answer 300

Change to 20 minutes on oxygen followed by 10 minutes breathing chamber air ## Footnote Alternative treatment gas mixtures with lower oxygen percentages can also be considered.

Question 301

How should a Diving Medical Officer respond to individual patient needs during oxygen treatment?

Answer 301

Tailor the guidelines to suit individual patient response to treatment ## Footnote This ensures personalized care during treatment.

Question 302

What is the likelihood of losing oxygen breathing capability during treatments?

Answer 302

Loss of oxygen breathing capability during treatments is a rare occurrence ## Footnote However, specific actions must be taken if it occurs.

Question 303

What actions should be taken if oxygen loss can be repaired within 15 minutes?

Answer 303

Maintain depth until repair is completed; resume treatment at point of interruption

Question 304

What should be done if oxygen loss repair takes longer than 15 minutes but less than 2 hours?

Answer 304

Maintain depth until repair is completed; complete treatment with maximum number of extensions if original table was Table 5, 6, or 6A ## Footnote This helps in managing treatment effectively.

Question 305

When does pulmonary oxygen toxicity develop?

Answer 305

Pulmonary oxygen toxicity is unlikely to develop on single Treatment Tables 5, 6, or 6A ## Footnote It can develop on Treatment Tables 4, 7, or 8 or with repeated Treatment Tables 5, 6, or 6A.

Question 306

What symptoms may indicate pulmonary oxygen toxicity during treatment?

Answer 306

End-inspiratory discomfort, substernal burning, severe pain on inspiration ## Footnote These symptoms may progress with prolonged exposure to oxygen.

Question 307

When should oxygen breathing be continued despite substernal burning?

Answer 307

If significant neurological deficit remains or if deterioration occurs upon interruption ## Footnote Oxygen should be continued until pain limits inspiration.

Question 308

What actions should be taken if oxygen loss can be repaired within 15 minutes?

Answer 308

Maintain depth until repair is completed; resume treatment at point of interruption ## Footnote This ensures continuity of care.

Question 309

What should be done if oxygen loss repair takes longer than 15 minutes but less than 2 hours?

Answer 309

Maintain depth until repair is completed; complete treatment with maximum number of extensions if original table was Table 5, 6, or 6A ## Footnote This helps in managing treatment effectively.

Question 310

What is the protocol if oxygen is lost during decompression using Tables 4, 7, or 8?

Answer 310

No compensation in decompression is needed if oxygen is lost. ## Footnote If decompression must be stopped due to worsening symptoms, stop decompression and continue treatment when oxygen is restored.

Question 311

What should be done if oxygen breathing cannot be restored in 2 hours?

Answer 311

Switch to the comparable air treatment table at current depth for decompression if 60 fsw or shallower. ## Footnote The rate of ascent must not exceed 1 fpm between stops.

Question 312

What adjustment should be made to depth gauges before starting recompression therapy at altitude?

Answer 312

Zero the chamber depth gauges to adjust for altitude. ## Footnote There is no need to 'Cross Correct' the treatment table depths.

Question 313

What is required for divers serving as inside tenders during hyperbaric treatments at altitude?

Answer 313

They require more decompression than at sea level. ## Footnote Tenders remaining in the chamber for the full treatment must breathe oxygen during the terminal portion.

Question 314

What is the minimum surface interval before no-decompression diving for tenders on Treatment Tables 5, 6, 6A, 1A, 2A, or 3?

Answer 314

A minimum of an 18-hour surface interval is required. ## Footnote For dives requiring decompression stops, a minimum of a 24-hour surface interval is needed.

Question 315

What is the minimum surface interval before diving for tenders on Treatment Tables 4, 7, and 8?

Answer 315

A minimum of a 48-hour surface interval is required. ## Footnote This is necessary prior to diving.

Question 316

How long should patients treated on Treatment Table 5 remain at the recompression chamber facility?

Answer 316

Patients should remain for 2 hours.

Question 317

What should be done for patients treated on Treatment Tables 6, 6A, 4, 7, 8, or 9?

Answer 317

They are likely to require a period of hospitalization. ## Footnote The Diving Medical Officer will determine the appropriate post-treatment observation period.

Question 318

What is the authorization requirement for releasing a patient after treatment?

Answer 318

No patient shall be released until authorized by a Diving Medical Officer (DMO). ## Footnote This ensures proper monitoring and safety post-treatment.

Question 319

How long should patients treated for type II DCS with complete relief of symptoms or treated on a TT 6 for type I pain remain at the recompression chamber facility?

Answer 319

Those treated for Type II decompression sickness should remain for 6 hours.

Question 320

What is the risk for inside tenders when using treatment table profiles?

Answer 320

Decompression sickness ## Footnote Inside tenders are at risk for decompression sickness after completing treatments.

Question 321

How long should inside tenders remain near the recompression chamber after treatment?

Answer 321

Inside tenders should remain in the vicinity of the recompression chamber for 1 hour.

Question 322

For which treatment tables should inside tenders remain within 60 minutes travel time of a recompression facility for 24 hours?

Answer 322

Treatment Table 4, 7, or 8 ## Footnote Inside tenders for these tables should remain within 60 minutes travel time for 24 hours.

Question 323

What must be done if a tender's oxygen breathing obligation exceeds the table stay time at 30 fsw?

Answer 323

Extend the time at 30 fsw ## Footnote The time at 30 fsw should be extended to meet the oxygen breathing obligations if the patient's condition permits.

Question 324

What should be done with patients who have residual symptoms after treatment?

Answer 324

Patients with residual symptoms should be transferred as directed by qualified medical personnel.

Question 325

Who should accompany ambulatory patients sent home after treatment?

Answer 325

Someone familiar with their condition ## Footnote They should be accompanied by someone who can return them to the recompression facility if needed.

Question 326

How long should patients treated for decompression sickness or arterial gas embolism wait to fly after treatment if they have complete relief?

Answer 326

Patients should not fly for at least 72 hours after treatment if they have complete relief.

Question 327

What is the required surface interval before flying for tenders on Treatment Tables 5, 6, 6A, 1A, 2A, or 3?

Answer 327

24-hour surface interval before flying.

Question 328

What is the minimum time that tenders on Treatment Tables 4, 7, and 8 should wait before flying?

Answer 328

72 hours

Question 329

What type of aircraft should be used for emergency air evacuation if possible?

Answer 329

Pressurized aircraft to one ata ## Footnote Unpressurized aircraft should be flown as low as safely possible.

Question 330

What should patients breathe during transport if available?

Answer 330

100 percent oxygen ## Footnote This is crucial during air evacuation.

Question 331

What may be used during emergency evacuation to maintain the patient at lata?

Answer 331

Emergency Evacuation Hyperbaric Stretcher ## Footnote This is an optional tool for maintaining pressure.

Question 332

What happens if residual symptoms do not improve after the first one or two treatments?

Answer 332

Consult a Diving Medical Officer for further evaluation ## Footnote NEDU or NDSTC consultation may also be appropriate.

Question 333

As the delay time increases between initial treatment and follow-up hyperbaric treatments, what happens to the probability of benefit?

Answer 333

It decreases ## Footnote Improvement has been noted even with delays of up to 1 week.

Question 334

What is the general guideline for discontinuing treatment?

Answer 334

No further sustained improvement after two consecutive treatments ## Footnote This indicates that the treatment may no longer be beneficial.

Question 335

For persistent Type II symptoms, what daily treatment may be used?

Answer 335

Daily treatment on Table 6 ## Footnote Twice-daily treatments on Treatment Tables 5 or 9 may also be used.

Question 336

What must be considered when choosing the treatment table for re-treatments?

Answer 336

Patient's medical condition and potential for pulmonary oxygen toxicity ## Footnote This is crucial for patient safety.

Question 337

How long should treatments not be administered on a daily basis without a break?

Answer 337

More than 5 days without at least 1 day break ## Footnote This is to prevent overexposure to treatments.

Question 338

What must divers diagnosed with any POIS or DCS do before returning to diving?

Answer 338

Refer to a DMO for clearance ## Footnote A waiver of physical standards may be required.

Question 339

Which manual provides guidance for returning to diving after treatment?

Answer 339

Bureau of Medicine and Surgery Manual (MANMED) P117 Article 15-102 ## Footnote This manual outlines the procedures for medical clearance.

Question 340

What should be done if a diver being treated dies during recompression therapy?

Answer 340

Consult a Diving Medical Officer before aborting treatment ## Footnote The procedures must be followed unless in mortal danger or to treat a more serious condition.

Question 341

What is the procedure if death occurs after initial recompression to 60, 165, or 225 feet?

Answer 341

Decompress the tenders on the Air/Oxygen schedule in the Air Decompression Table ## Footnote The depth must be equal to or deeper than the maximum depth attained during treatment.

Question 342

What is the decompression rate if death occurs after leaving the initial treatment depth on Treatment Tables 6 or 6A?

Answer 342

Decompress at 30 fsw/min to 30 fsw and breathe oxygen at that depth ## Footnote Follow the times indicated in Table 17-6.

Question 343

What is the first step if a chamber is deeper than 60 feet and treatment must be aborted?

Answer 343

Go immediately to 60 feet ## Footnote This is to ensure safety before further action.

Question 344

What should be done if the current depth is shallower than 60 fsw?

Answer 344

Breathe oxygen for a period equal to the sum of all decompression stops deeper than the current depth ## Footnote Then continue decompression on the Air/Oxygen schedule.

Question 345

What should be done after evacuating all chamber occupants due to impending natural disaster/mechanical failure?

Answer 345

Immediately evacuate to the nearest recompression facility ## Footnote Treat according to Figure 17-1.

Question 346

When should drug therapy be administered?

Answer 346

Only after consultation with a Diving Medical Officer ## Footnote Administered by qualified inside tenders.

Question 347

What is the recommended oxygen source for treating Decompression Sickness (DCS)?

Answer 347

High-flow (15 liters/minute) oxygen source with a reservoir mask or a demand valve ## Footnote Surface oxygen should be used for all cases of DCS until the diver can be recompressed.

Question 348

What is the maximum duration a patient can generally tolerate 100% oxygen?

Answer 348

Up to 12 hours ## Footnote The decision to continue administering oxygen beyond this time must weigh the perceived benefits against the risk of pulmonary oxygen toxicity.

Question 349

What should be administered to all individuals suffering from DCS?

Answer 349

Fluids ## Footnote Fluids should be given unless the patient is suffering from the chokes (pulmonary DCS).

Question 350

What types of oral fluids are acceptable for conscious divers suffering from DCS?

Answer 350

Water, Gatorade-like drinks ## Footnote Oral fluids are acceptable if the diver is fully conscious and able to tolerate them.

Question 351

What should be administered if a DCS patient cannot tolerate oral fluids?

Answer 351

Intravenous fluids ## Footnote Intravenous fluids should be administered when oral fluids cannot be tolerated.

Question 352

Which type of fluids should not be used for DCS treatment?

Answer 352

D5W (dextrose in water without electrolytes) ## Footnote There is no data demonstrating the superiority of crystalloids over colloids for DCS treatment.

Question 353

What are the most reasonable fluid choices for DCS treatment?

Answer 353

Lactated Ringers or normal saline ## Footnote Colloids are more expensive than Lactated Ringers or normal saline.

Question 354

What is the optimal urinary output range indicating adequate intravascular volume?

Answer 354

0.5-1.0cc/kg/hour ## Footnote This range is evidence of adequate intravascular volume during treatment.

Question 355

What condition can cause divers to lose 250-500 cc of fluids per hour?

Answer 355

Immersion diuresis ## Footnote This condition is a factor to consider when treating DCS.

Question 356

What should be avoided during DCS treatment?

Answer 356

Fluid overloading ## Footnote Care should be taken to avoid fluid overload while treating DCS.

Question 357

What condition causes abnormal pulmonary function and leakage of fluids into the alveolar spaces?

Answer 357

Chokes (pulmonary DCS) ## Footnote Chokes is a condition associated with decompression sickness (DCS) affecting the lungs.

Question 358

What should be avoided in the treatment of DCS due to increased likelihood of hemorrhage?

Answer 358

Anticoagulants ## Footnote Routine use of anticoagulants is not recommended except in specific cases.

Question 359

What anticoagulant is recommended for patients with lower extremity paralysis caused by neurological DCS or AGE?

Answer 359

Low molecular weight heparin (LMWH) ## Footnote Enoxaparin 30 mg subcutaneously every 12 hours is recommended.

Question 360

What alternative methods can be used to prevent DVT in paralyzed patients, although less effective than LMWH?

Answer 360

Compression stockings or intermittent pneumatic compression ## Footnote These methods are not as effective as LMWH for DVT prevention.

Question 361

Is routine use of anti-platelet agents recommended in patients with neurological DCS?

Answer 361

No ## Footnote Their use may worsen hemorrhage in spinal cord or inner ear decompression illness.

Question 362

What is the recommendation for lidocaine in the treatment of DCS?

Answer 362

Not recommended ## Footnote Lidocaine has no current recommendation for treating any type of DCS.

Question 363

What treatment is recommended for elevated body temperature in patients with brain or spinal cord damage?

Answer 363

Aggressive treatment of elevated body temperature ## Footnote Hot environments should be avoided to prevent temperature elevation.

Question 364

What should be used for all cases of Arterial Gas Embolism (AGE)?

Answer 364

Surface oxygen ## Footnote Surface oxygen is recommended similar to DCS treatment.

Question 365

What is the intramuscular administration dosage of lidocaine for AGE?

Answer 365

4-5 mg/kg ## Footnote This typically produces therapeutic plasma concentration 15 minutes after dosing.

Question 366

What condition causes abnormal pulmonary function and leakage of fluids into the alveolar spaces?

Answer 366

Chokes (pulmonary DCS) ## Footnote Chokes is a condition associated with decompression sickness (DCS) affecting the lungs.

Question 367

What should be avoided in the treatment of DCS due to increased likelihood of hemorrhage?

Answer 367

Anticoagulants ## Footnote Routine use of anticoagulants is not recommended except in specific cases.

Question 368

What anticoagulant is recommended for patients with lower extremity paralysis caused by neurological DCS or AGE?

Answer 368

Low molecular weight heparin (LMWH) ## Footnote Enoxaparin 30 mg subcutaneously every 12 hours is recommended.

Question 369

What alternative methods can be used to prevent DVT in paralyzed patients, although less effective than LMWH?

Answer 369

Compression stockings or intermittent pneumatic compression ## Footnote These methods are not as effective as LMWH for DVT prevention.

Question 370

Is routine use of anti-platelet agents recommended in patients with neurological DCS?

Answer 370

No ## Footnote Their use may worsen hemorrhage in spinal cord or inner ear decompression illness.

Question 371

What is no longer recommended for the treatment of DCS due to lack of significant benefits?

Answer 371

Steroids ## Footnote Steroids may worsen CNS injury outcomes through elevated blood glucose levels.

Question 372

What is the recommendation for lidocaine in the treatment of DCS?

Answer 372

Not recommended ## Footnote Lidocaine has no current recommendation for treating any type of DCS.

Question 373

What treatment is recommended for elevated body temperature in patients with brain or spinal cord damage?

Answer 373

Aggressive treatment of elevated body temperature ## Footnote Hot environments should be avoided to prevent temperature elevation.

Question 374

What should be used for all cases of Arterial Gas Embolism (AGE)?

Answer 374

Surface oxygen ## Footnote Surface oxygen is recommended similar to DCS treatment.

Question 375

What are the potential major side effects of Lidocaine when administered in doses greater than recommended?

Answer 375

Paresthesias, ataxia, seizures ## Footnote Lidocaine should only be administered under the supervision of a DMO or other qualified physician.

Question 376

Why do fluid replacement recommendations for AGE differ from those for DCS?

Answer 376

CNS injury in AGE may be complicated by cerebral edema, worsening with increased fluid load ## Footnote Fluid overload may cause further injury to the diver.

Question 377

What type of fluids are recommended for fluid replacement in AGE?

Answer 377

Colloids ## Footnote Colloids help maintain intra-vascular volume and minimize extra-vascular leakage.

Question 378

What should be the target urine output for an injured diver suffering from AGE?

Answer 378

0.5 cc/kg/hour ## Footnote IV rates should be adjusted to maintain this output.

Question 379

Should anticoagulants be used routinely in the treatment of AGE?

Answer 379

No ## Footnote Enoxaparin may be administered subcutaneously every 12 hours after initial recompression therapy in patients suffering from paralysis.

Question 380

What is the recommendation regarding the use of anti-platelet agents in patients with AGE?

Answer 380

Routine use is not recommended ## Footnote This includes medications like Aspirin.

Question 381

Are steroids recommended for the treatment of AGE?

Answer 381

No ## Footnote Steroids do not significantly reduce neurologic residual and may worsen CNS injury due to elevated blood glucose levels.

Question 382

What is the recommended approach for treating elevated body temperature in patients with brain or spinal cord damage?

Answer 382

Aggressive treatment ## Footnote Hot environments should be avoided to prevent elevated body temperature.

Question 383

When is it acceptable for a patient to be kept awake during recompression treatments?

Answer 383

During oxygen breathing periods at depths greater than 30 feet ## Footnote Vital signs should be monitored regularly while the patient is asleep.

Question 384

What should be monitored while a patient is asleep during decompression stops?

Answer 384

Vital signs: pulse, respiratory rate, blood pressure ## Footnote Any significant change would warrant arousing the patient to ascertain the cause.

Question 385

When can food be taken by chamber occupants?

Answer 385

At any time ## Footnote This allows for flexibility in maintaining nutrition during diving activities.

Question 386

What must every diving activity maintain for emergencies?

Answer 386

Emergency medical equipment ## Footnote This equipment is essential for immediate response to diving accidents.

Question 387

What is the purpose of having both primary and secondary emergency kits?

Answer 387

To provide immediate access to essential items and manage contamination risks ## Footnote The primary kit is for immediate use, while the secondary kit is for items that can be locked in as needed.

Question 388

What does the primary emergency kit contain?

Answer 388

Diagnostic and therapeutic equipment ## Footnote This kit must be inside the chamber during all treatments.

Question 389

What is stored in the secondary emergency kit?

Answer 389

Equipment and medicine that does not need to be available immediately ## Footnote This kit can be locked into the chamber as necessary.

Question 390

Are the contents of the emergency kits restrictive?

Answer 390

No, they are considered the minimum requirement ## Footnote Additional items may be added based on local medical preferences.

Question 391

What is a key recommendation for diving activities with an assigned Diving Medical Officer?

Answer 391

Augment with a fully capable monitor defibrillator ## Footnote This enhances emergency response capabilities.

Question 392

Are AEDs approved for use under pressure in a hyperbaric environment?

Answer 392

No ## Footnote This is due to electrical safety concerns.

Question 393

When can food be taken by chamber occupants?

Answer 393

At any time ## Footnote This allows for flexibility in maintaining nutrition during diving activities.

Question 394

What must every diving activity maintain for emergencies?

Answer 394

Emergency medical equipment ## Footnote This equipment is essential for immediate response to diving accidents.

Question 395

Minimum manning levels specified in Table 17-1.

Answer 395

Question 396

Emergency manning levels specified in Table 17-1.

Answer 396

Question 397

Ideal manning levels specified in Table 17-1.

Answer 397