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DIVE EMERGENCIES

DIVE EMERGENCIES. OBJECTIVES. Recognize Signs and Symptoms of Patients with a Dive Related Complaint Discuss Treatment Considerations for Patients with a Suspected Dive Emergency Review Destination Decisions for Patients with a Decompression Emergency. Scuba Diving. S - Self

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DIVE EMERGENCIES

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  1. DIVEEMERGENCIES

  2. OBJECTIVES • Recognize Signs and Symptoms of Patients with a Dive Related Complaint • Discuss Treatment Considerations for Patients with a Suspected Dive Emergency • Review Destination Decisions for Patients with a Decompression Emergency.

  3. Scuba Diving S - Self C – Contained U – Underwater B – Breathing A - Apparatus

  4. MEDICAL ISSUES OF DIVERS • Environmental Exposures • Hazardous Marine Life • Pressure/Squeeze Injuries • Gas Related Issues

  5. Barotrauma • Descent Barotrauma • Ascent Barotrauma

  6. GAS RELATED ISSUES • Nitrogen Narcosis • Decompression Sickness

  7. Distribution of Cases According to Diagnosis

  8. Cause of Death in Dive Fatalities 1999-2002

  9. BAROTRAUMA OF DESCENT • Tissue Distortion • Vascular Engorgement • Mucosal Edema • Hemorrhage and Damage

  10. THE EARS

  11. Barotrauma • Barotitis Externa • Barotitis Media • Barotitis Intera • Sinus Barotrauma • Pulmonary Barotrauma

  12. Barotrauma Risk Factors • URI • Allergies • Smoking • Mucosal Polyps • Prior Maxillofacial trauma/surgery • Excessive Auto inflation maneuvers

  13. Pulmonary Barotrauma • Air Embolism • Subcutaneous emphysema • Pneumothorax • Mediastinal emphysema

  14. Air Embolism • Gas entry into the circulation from ruptured pulmonary veins • Air bubbles travel into the arterial blood supply and into the body tissues • Air bubbles become lodged in tissues blocking blood flow

  15. Air Embolism Signs and Symptoms: • Most occur within 2-3 minutes • Cardiac – Cardiac arrest, arrhythmias • Neurological – focal paralysis, sensory disturbance, deafness, vertigo, seizures, altered mental status

  16. Subcutaneous Emphysema Expanding air accumulates under the skin around the neck and clavicle Signs and Symptoms • Fullness in the neck • Voice changes • Neck swelling • Crackling under the skin

  17. Mediastinal Emphysema Air accumulates in the mediastinum pressing on the heart and major vessels; interfering with circulation Signs and Symptoms • Sub-Sternal Chest Pain • Shortness of Breath • Syncopal • Shock • Cyanosis

  18. Pneumothorax Air in the pleural cavity causing partial or complete collapse of the lung Signs and Symptoms • Chest Pain • Difficulty Breathing • Unequal Breath Sounds

  19. Decompression Sickness DCS Type I • 30% of the cases reported to Diving Alert Network • Mild - skin, lymphatic, musculoskeletal DCS Type II • 70% of reported cases to Diving Alert Network • Moderate to severe - pulmonary, cardiovascular, neurological

  20. DCS Type I Cutaneous • pruritis, SQ emphysema, rashes Musculoskeletal • joint pain, numbness Lymphatic • Localized obstruction

  21. DCS Type II Pulmonary • Venous Air Embolism • Signs and Symptoms: Chest Pain, cough, dyspnea, shock, pulmonary edema • Often rapidly fatal

  22. DCS Type II Cardiovascular • Dizziness • Chest Pain • Shortness of Breath • Myocardial Infarction

  23. DCS Type II Neurological • Blurred vision, headache • Numbness to extremities • Paralysis in lower extremities • Stroke symptoms

  24. DCS – Percentage in Hours of Onset of Symptoms

  25. Nitrogen Narcosis • Usually occurs at depths >100ft • Euphoria • Drowsy • Lack of Coordination • Poor Judgment/Memory • Symptoms Recede at Shallow Depths

  26. Heart Disease • The #1 cause of death in the United States. • The cause of 20 -30% of deaths while scuba diving. • The direct cause of death for 26% of diver fatalities over 35 years of age. • 25% of divers involved in diving fatalities were taking heart medications. DAN – Fatality Report 2006

  27. Patient Assessment • BSI • Scene Size-up • Initial Assessment • Focused History and Physical

  28. Scene Size-Up • Personal Safety • Patient Safety • Environment • Number of Patients • Additional Resources/Equipment

  29. Initial Assessment • Airway/Spinal Immobilization • Breathing • Circulation • Major Disabilities • Determine Chief Complaint • Expose • Transport Decision

  30. Focused History and Physical • Vital Signs • Neurological Status • Dive History • Rapid Trauma Assessment • Manage specific problems/injuries • Rapid Head to Toe Exam

  31. Dive History • Number Depth/Time of Dive • Rapid ascent • Uncontrolled/Panic Ascent • Decompression Stop • Dive Computer/Tables • Dive Buddy/Solo • Tank Pressure • Type of Compressed breathing gas

  32. Dive Equipment • Regulator • Tank • Buoyancy Compensator • Weight Belt • Computer

  33. Decompression EmergenciesPatient Destination Policy Reference # 518 To provide a procedure for transporting patients with potential decompression emergencies to the most accessible medical facility appropriate to their needs

  34. Provider Agency Responsibilities • Contact Base Hospital or designated dispatch center for any patient with a suspected decompression emergency • Obtain a dive incident history of patient and dive partner • Coordinate patient transport to the appropriate facility • Retrieve patients dive equipment

  35. Medical Control • Contact the Medical Alert Center • Base Hospital Contact • Standing Field Protocols

  36. Transport Considerations Patient with a history of recent underwater compressed air: • Immediate • Emergent • Non-emergent

  37. Immediate Patients presenting: • Unconscious or • Apneic or • Pulseless Transport to an approved hyperbaric chamber

  38. Emergent Patients presenting: • Severe Neurological symptoms, or • Severe dyspnea, or • Chest discomfort Transport to a hyperbaric chamber and/or the MAR after consult with the hyperbaric Camber MD

  39. Non-Emergent Patients presenting: • Minor neurological symptoms, or • Delayed symptoms after flying, or • Delayed minor symptoms after 24 hours Transport to MAR with potential secondary Transfer to hyperbaric chamber after Consultations with hyperbaric MD

  40. Air Transport Considerations • Early Deployment • Equipment • Weather • Landing Zone

  41. Los Angeles CountyHyperbaric Chambers • USC - Catalina Island (only 24 hour emergencyreceiving) • UCLA – Westwood • Long Beach Memorial • Beverly Hills Hyperbaric Know the Location of YOUR closest Hyperbaric Chambers

  42. DELAYS IN TRANSPORT MAY RESULT IN PERMENENT DISABLITY OR DEATH!!!

  43. Scenario #1 You are call to the beach to a 25 old female complaining of numbness in both hands with bilateral knee pain. Patient is A + O X 3, BP 110/74, P 104, Resps 32, Pulse Oximetry 98% What other questions would assist you in your focused history and physical examination?

  44. Scenario #1 • What is the possible cause of this patients signs and symptoms? • What would be the treatment and transport considerations for a patient with this presentation?

  45. Scenario #2 You respond to a dive boat, you find a man with no pulses, no respirations. His dive buddy tells you that they were at 40 ft depth. He witnessed his friend rush to the surface without stopping. What is the probable cause of this patients loss of consciousness?

  46. Scenario #2 What additional information may be useful to obtain in your focused history and physical? What are the treatment and transport priorities for this patient?

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