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Diver First Responder (DFR) Module B: Diving Emergencies 1 Barotrauma

Diver First Responder (DFR) Module B: Diving Emergencies 1 Barotrauma. DFR JAN 2011: MODULE B: EMERG 2. DFR Course. DFR JAN 2011: MODULE B: EMERG 2. In Module B: We will Cover. Diving Emergencies 1 Overview - Physics and physiology Decompression Illness (DCI) Decompression Sickness

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Diver First Responder (DFR) Module B: Diving Emergencies 1 Barotrauma

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  1. Diver First Responder(DFR)Module B: Diving Emergencies 1Barotrauma DFR JAN 2011: MODULE B: EMERG 2

  2. DFR Course DFR JAN 2011: MODULE B: EMERG 2

  3. In Module B: We will Cover • Diving Emergencies 1 • Overview - Physics and physiology • Decompression Illness (DCI) • Decompression Sickness • Pulmonary Barotrauma (Burst Lung) DFR JAN 2011: MODULE B: EMERG 2

  4. Common Terminology DFR JAN 2011: MODULE B: EMERG 2

  5. Physics & Physiology Overview PRESSURE Atmospheric + Water pressure = Absolute Pressure 1 bar 2 bar 10 metres 1 bar DFR JAN 2011: MODULE B: EMERG 2

  6. 1 bar 0.8 0.2 2 bar 1.6 0.4 3 bar 2.4 0.6 4 bar 3.2 0.8 5 bar 4.0 1.0 Absolute Pressure Partial Pressures Depth PpN2 PpO2 0 10 m 20 m 30 m 40 m DFR JAN 2011: MODULE B: EMERG 2

  7. Decompression Illness DFR JAN 2011: MODULE B: EMERG 2

  8. Decompression Illness DCI Decompression Illness DCS Decompression Sickness refers to the conditions caused by inert nitrogen gas coming out of solution within the body Burst Lung refers to lung over-expansion Injuries DFR JAN 2011: MODULE B: EMERG 2

  9. DCS: Summary • The deeper the dive - the more gas is absorbed • The longer the diver is at pressure - the more gas will diffuse into the tissues • If pressure is removed too rapidly: Gas expands & comes out of solution, forms bubbles • Onset: 50% within 1 hour - 90% within 6 hours • Symptoms vary: Skin rash … to … severe CNS bend DFR JAN 2011: MODULE B: EMERG 2

  10. A S C E N T Supersaturation Saturation Level of N2 Diver’s Level of N2 Depth 0 M Bubbling Out 10 M Supersaturated 20 M Saturated 30 M Undersaturated DFR JAN 2011: MODULE B: EMERG 2

  11. Decompression Sickness • CONTRIBUTING FACTORS • Shortened / omitted decompression • Rapid ascent / loss of buoyancy • Dehydration / cold / exposure • Age / overweight / fatigue / smoking / alcohol • Drugs - prescription or otherwise • Pre-existing medical conditions / Patent Foramen Ovale • Heavy exercise • Illness / injuries • Previous DCS DFR JAN 2011: MODULE B: EMERG 2

  12. Decompression Sickness • SYMPTOMS • Generally unwell / Extreme fatigue • Skin itching / Shortness of breath • Pain in the limbs and joints / pins & needles / loss of sensation • Dizziness / visual disturbance / • Muscle weakness / loss of sensation • Inability to control bowel or bladder functions • Confusion / disorientation • SIGNS • A blotchy, mottled, red rash on skin • Loss of power leading to paralysis • Staggering / loss of balance • Choking / shortness of breath / Itching • Collapse or unconsciousness DFR JAN 2011: MODULE B: EMERG 2

  13. Decompression Sickness • TREATMENT • Monitor A-B-C, administer 100% oxygen, alert Emergency Medical Services (EMS) – Channel 16 or dial 999 or 112. • If concerned about vomiting - recovery position • Do not administer anything (solids, liquids, medication) • Hyperbaric treatment as soon as possible Monitor buddy • Record all details • NO IN-WATER RECOMPRESSION ! DFR JAN 2011: MODULE B: EMERG 2

  14. Handover to EMS • This slide for info only: • PHECC Clinical Practice Guidelines • [CPG] • Decompression Illness (DCI) • For use by trained: • EMT • PARAMEDIC • ADVANCED PARAMEDIC Entonox absolutely contraindicated DFR JAN 2011: MODULE B: EMERG 2

  15. DFR JAN 2011: MODULE B: EMERG 2

  16. PulmonaryBarotrauma DFR JAN 2011: MODULE B: EMERG 2

  17. Effect of Boyle’s law Surface 0 metres - 1 bar absolute 10 metres - 2 bar absolute 20 metres - 3 bar absolute 30 metres - 4 bar absolute DFR JAN 2011: MODULE B: EMERG 2

  18. Pulmonary Barotrauma • BURST LUNG • Excess air pressure in the lungs (usually from not exhaling properly on ascent) • over-expands the lung • the lung ruptures • SEVERAL CONDITIONS MIGHT ARISE ........ • Air embolism (Arterial gas embolism) • Pneumothorax • Mediastinal emphysema • Subcutaneous emphysema DFR JAN 2011: MODULE B: EMERG 2

  19. Subcutaneous Emphysema Pneumothorax Air escaping into the Pleural cavity causes the lung to collapse Air from Mediastinum collects under skin of neck compressing the Trachea Mediastinal Emphysema Arterial Gas Embolism Bubbles of Air entering the Blood Vessels Air escaping into the Mediastinum causes compression of the heart and lungs Bubbles in Carotid Artery leading to Brain Ruptured Alveoli and Blood Vessels DFR JAN 2011: MODULE B: EMERG 2

  20. Pulmonary Barotrauma • SYMPTOMS • Onset usually on surfacing • Chest pain / shortness of breath • Dizziness / visual blurring • Weakness • SIGNS • Breathing - Difficult - rapid – shallow – absent • Swelling of the neck / Crackling sound / feeling around the neck • Paralysis or weakness of the limbs • Cough / Cyanosis; blue lips, fingertips • Change in voice • Convulsions ..... Unconsciousness DFR JAN 2011: MODULE B: EMERG 2

  21. Pulmonary Barotrauma • Treatment • Immediate Recompression • Monitor A, B, C / 100% oxygen / Alert EMS • No food or fluids • If injuries permit; comfortable position • Keep victim at a comfortable temperature • Check for bleeding and other injuries • Recognise and treat for shock DFR JAN 2011: MODULE B: EMERG 2

  22. DFR JAN 2011: MODULE B: EMERG 2

  23. Reading • CFT Trainee + Club Diver Course Materials • DDRC Underwater Diving Accident Manual • Ignore pages 13-15 • CFT DFR course does not currently teach • ‘Five Minute Neuro Exam’ DFR JAN 2011: MODULE B: EMERG 2

  24. Module B: Diving Emergencies 1Barotrauma • Has covered: • Overview - Physics and physiology • Emergency care of Decompression Illness (DCI) • Decompression Sickness • Pulmonary Barotrauma (Burst Lung) • Closing Statement Effective first response followed by prompt treatment by the emergency services, usually with recompression, is necessary to treat barotrauma incidents DFR JAN 2011: MODULE B: EMERG 2

  25. DFR JAN 2011: MODULE B: EMERG 2

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