CLINICAL CARE

Question 1

(1) During a dive a diver’s blood and tissues absorb additional nitrogen/helium from the lungs when at depth.
(2) If a diver ascends too fast this excess gas will separate from solution and form bubbles. These bubbles produce mechanical and biochemical effects that lead to a condition known as decompression sickness***.

Answer 1

Decompression Sickness (DCS)

Question 2

involves the skin, lymphatic system, muscles, and joints. It is not life threatening

Answer 2

Type I

Question 3

itching and Cutis Marmorata. Cutis Marmorata is characterized by a marbled bright red***, purplish or even bluish pattern on the skin.

Answer 3

Skin Symptoms

Question 4

outside of the thorax, knees, ankle, elbow and wrist. Pain is typically a dull achy pain that is unable to be pinpointed.

Answer 4

Joint Pain

Question 5

***Joint Pain and Skin Symptoms

Pain, marbling, and swelling***

Answer 5

DCS Type I

Question 6

Treatment of DCS Type I

Answer 6

(a) Complete a full neurological exam to rule out AGE or DCS Type II **
(b) 100% Surface Oxygen via non rebreather mask
(c) Transport to the nearest Recompression Chamber
* **NOTE: If transport by helicopter maintain an altitude less than 1000ft. **

Question 7

a serious & possibly life threatening illness. DCS Type II symptoms are divided into three categories (Neurological, Inner Ear & Cardio Pulmonary)

Answer 7

Type II DCS

Question 8

Neurological DCS

Answer 8

1) Numbness
2) Paresthesia’s
3) Muscle weakness
4) Mental status changes
5) Impaired urinary function

Question 9

Inner Ear DCS

“staggers”

Answer 9

1) Tinnitus
2) Hearing Loss **
3) Vertigo **
4) Dizziness
5) Nausea *
6) Vomiting*

Question 10

Cardiopulmonary DCS

“Chokes”

Answer 10

1) Chest pain
2) Painful inspiration
3) Irritating Cough
4) Tachypnea
5) Lung congestion
6) Complete circulatory collapse *** Biggest risk factor

Question 11

Treatment of DCS Type II

Answer 11

(a) Complete a full neurological exam to rule out AGE (Arterial gas embolism)

• **NOTE: Treatment for DCS TypeII and AGE are the same.
  (b) 100% Surface Oxygen via non rebreather mask
  (c) Transport to the nearest Recompression Chamber
• **NOTE: If transport by helicopter maintain an Altitude less than 1000ft

Question 12

***Neurological, Inner Ear, and Cardiopulmonary symptoms

Answer 12

DCS Type II

Question 13

occurs when gas is forced through torn lung tissue into the loose mediastinal tissues in the middel of the chest surrounding the heart, trachea, and major vessels.

Answer 13

Pulmonary Over Inflation Syndrome

Question 14

1) Mild to moderate pain under the breastbone
2) Pain that radiates to the shoulder or back.
3) Fullness around the neck and difficulty swallowing
4) Voice
5) Palpation of the skin near the trachea may result in crepitus (cracking or crunching sound)

Answer 14

Mediastinal/Subcutaneous

Question 15

Mediastinal/Subcutaneous

Answer 15

Mediastinal emphysema

Question 16

Treatment of Mediastinal emphysema

Answer 16

(a) Neuro to rule out AGE **
(b) Cardio/Lung exam to rule out pnuemothorax **
(c) 100% surface oxygen
(d) Shallow recompression to 5-10FSW may be warranted until symptoms resolve
* not my call. has to come from someone smarter.

Question 17

Caused by air leaking from the tissues of the lungs into the space between the lungs and chest wall. A simple pneumothorax is a onetime escape of gas, while a tension pneumothorax is caused when air continues to escape and collapses the lung which compromises cardiac function.

Answer 17

Pneumothorax

Question 18

(a) Sudden, sharp chest pain **
(b) Shortness of breath **
(c) Labored breathing ***
(d) Rapid heart rate
(e) Weak pulse
(f) Anxiety (impending doom)

Answer 18

Pneumothorax

Question 19

Treatment of Pneumothorax

Answer 19

(a) Heart/lung exam
(b) 100% O2
(c) Needle-decompression or chest tube as warranted

Question 20

(1) Damage to body tissues from the mechanical effects of pressure, results when pressure differentials between body cavites
(2) During a normal ascent and decompression procedures, these gasses come out of the diver’s body at a manageable rate.

Answer 20

Barotrauma

Question 21

Types of Barotrauma

Answer 21

(1) Ear squeezes
(2) Sinus squeeze
(3) Tooth squeeze

Question 22

The Eustacian tube enables a diver to equalize pressure in ***

Answer 22

the Middle ear.

Question 23

If the diver cannot equalize the pressure in the Middle ear the diver will experience a “squeeze”. A squeeze may result in

Answer 23

Tympanic membrane rupture, tissue damage, and possible injury to the Coclea/vestibular apparatus.

Question 24

Symptoms of Ear squeeze

Answer 24

(a) Sharp pain in the ear
(b) Rupture of the tympanic membrane
(c) Vertigo
(d) Tinnitus
(e) Hearing Loss
(f) Nausea/Vomiting

Question 25

Treatment of Ear squeeze

Answer 25

(a) HEENT exam (b) Decongestants (c) Pain medication * **NOTE: If a ruptured eardrum is suspected do not administer medication directly into the ear canal without consultation of a ear, nose & throat Specialist.

Question 26

(1) A diver’s air supply can be contaminated by _____ when the compressor intake is placed to close to the compressor’s engine exhaust

Answer 26

carbon monoxide

Question 27

seriously interferes with the bloods ability to carry the oxygen required for the body to function normally. The affinity of carbon monoxide for hemoglobin is 210 times that of Oxygen.

Answer 27

carbon monoxide

Question 28

Symptoms of Carbon Monoxide Poisoning

Answer 28

(1) Headache (2) Dizziness (3) Confusion (4) Nausea (5) Vomiting (6) Tightness across the forehead

Question 29

Treatment of Carbon Monoxide Poisoning

Answer 29

(1) Getting the diver to fresh air (2) 100% surface oxygen (3) Transport to hyperbaric or medical treatment facility. ***Note: Hyperbaric therapy is the definitive treatment of choice and transportation to a recompression chamber should not be delayed except to stabilize the patient.

Question 30

(1) an abnormally high level of carbon DIOXIDE (not monoxide) ** in the blood and body tissues. (2) In diving operations, hypercapnia is generally the result of a buildup of carbon dioxide in the breathing supply or an inadequate respiratory minute volume.

Answer 30

Hypercapnia

Question 31

Symptoms of Hypercapnia

Answer 31

(1) Increased breathing rate (2) Shortness of breath (3) Confusion or feelings of euphoria (4) Inability to concentrate (5) Increased sweating (6) Drowsiness (7) Headache (8) Loss of consciousness (9) Convulsions

Question 32

Treatment of Hypercapnia

Answer 32

(1) Decreasing the level of exertion to reduce CO2 production (2) Increasing helmet and lung ventilation to wash out excess CO2 (3) Shifting to alternate breathing source of aborting the dive if defective equipment is the cause.

Question 33

Exposure to a partial pressure of oxygen above that encountered in normal daily living may be toxic to the body. The extent of the toxicity is dependent upon both the oxygen partial pressure and the exposure time

Answer 33

Central Nervous System Oxygen Toxicity

Question 34

The two areas of the body affected by Central Nervous System Oxygen Toxicity are the

Answer 34

Central Nervous System and the Pulmonary System.

Question 35

Symptoms of Central Nervous System Oxygen Toxicity

Answer 35

(1) Tunnel vision, decreased peripheral vision, and other visual symptoms (2) Tinnitus (3) Confusion/Euphoria (4) Inability to concentrate (5) Increased sweating (6) Drowsiness (7) Headache (8) Loss of consciousness (9) Convulsions

Question 36

Treatment of Central Nervous System Oxygen Toxicity

Answer 36

(1) Immediately ascend *** (2) Shift to a breathing mixture with lower oxygen percentage *** (3) In a recompression chamber, remove oxygen mask and follow emergency procedures

Question 37

sometimes called low pressure oxygen poisoning, can occur whenever the oxygen partial pressure exceeds 0.5ata. A 12 hour exposure to a partial pressure of 1ata will produce mild symptoms and measureable decreases in lung function.

Answer 37

Pulmonary Oxygen Toxicity

Question 38

Symptoms of Pulmonary Oxygen Toxicity.

Answer 38

(1) Burning sensation during inspiration (2) Pain during inspiration (3) Cough (4) Decreased pulmonary function

Question 39

Treatment of Pulmonary Oxygen Toxicity.

Answer 39

(1) If the patient cannot continue with respiratory discomfort, remove the patient from O2 (2) Consult DMO (Diving Medical Officer) to modify treatments, increasing air time of air breaks between oxygen periods.

Question 40

While conducting breath hold operations, oxygen PPO2 is higher at depth. During ascent the PPO2 decreases and increases the risk of hypoxia and unconsciousness. ***The biggest risk of shallow water black out is subsequent drowning.

Answer 40

Shallow Water Blackout

Question 41

Symptoms of Shallow Water Blackout

Answer 41

(1) Unconsciousness close to the surface or subsurface (2) Hypoxia (3) Subsequent drowning (4) Cardiac/Respiratory arrest

Question 42

Treatment of Shallow Water Blackout

Answer 42

(1) In water: Ventilation only, open airway, check breathing, provide 5 rescue breaths (2) Do not attempt compressions in the water (3) Rule out cardiac arrest once on the boat/shore (4) If the patient is pulseless continue CPR utilizing ABCs (Airway, Breathing, Circulation) *** (5) Transport to the nearest emergency department * **NOTE: Immediate CPR and application of an Automated External Defibrillator (AED) is indicated for a diver with no pulse or respirations (cardiopulmonary arrest). Access to advanced cardiac life support (ACLS) is a higher priority than recompression. If the pulseless diver regains vital signs continue, or begin, transport to the nearest critical care facility prior to recompression.

Question 43

(1) Occurs during swimming or diving operations. Often in young individuals with no predisposing conditions. (2) Believed to be related to exertion, immersion in cold water and overhydrating

Answer 43

Swimmer Induced Pulmonary Edema (SIPE)

Question 44

Symptoms of Swimmer Induced Pulmonary Edema (SIPE)

Answer 44

(1) Dull to sharp substernal chest pain (2) Hemoptysis (coughing up blood) (3) Shortness of breath (4) Frothy sputum (5) Shortness of breath

Question 45

Treatment of Swimmer Induced Pulmonary Edema (SIPE)

Answer 45

(1) Remove patient from the wet/cold environment (2) Supplemental oxygen (3) Complete heart/lung exam (4) EKG (5) X-ray within 2 hours (6) For critical patients, follow BLS/ACLS algorithms and transport to Emergency Department