diver first responder (dfr) module b: diving emergencies 1 barotrauma dfr jan 2011: module b: emerg...

Diver First ResponderDiver First Responder(DFR)(DFR)

Module B: Diving Emergencies 1Module B: Diving Emergencies 1BarotraumaBarotrauma

DFR JAN 2011: MODULE B: EMERG 2

DFR CourseDFR Course

Module Title Content

A PHECC CFR Course Basic Life Support & AED

B Diving Emergencies 1 Barotrauma

C Diving Emergencies 2 Non-Pressure Related Emergencies

D Diving Emergencies 3 Emergency Care

E Oxygen Treatment Theory and Practice

2DFR JAN 2011: MODULE B: EMERG 2

In Module B: We will CoverIn Module B: We will Cover

• Diving Emergencies 1Diving Emergencies 1– Overview - Physics and physiologyOverview - Physics and physiology

• Decompression Illness (DCI)Decompression Illness (DCI)– Decompression SicknessDecompression Sickness– Pulmonary Barotrauma (Burst Lung)Pulmonary Barotrauma (Burst Lung)


Common TerminologyCommon TerminologyTerm Definition

Indication Uses for a medication / drug

Contra-indication Circumstances where a medication should not be given

Medical Emergency Acute injury or illness that poses an immediate risk to a person's life or long term health

Symptom What the patient experiences

Sign What the care-giver sees


PRESSURE

AtmosphericAtmospheric+ +

Water pressureWater pressure==

Absolute PressureAbsolute Pressure

Physics & Physiology OverviewPhysics & Physiology Overview

5

2 bar2 bar

1 bar1 bar

10 metres10 metres 1 bar1 bar


DepthAbsolute Pressure

Partial Pressures

0

10 m

20 m

30 m

40 m

1 bar 0.8 0.2

2 bar 1.6 0.4

3 bar 2.4 0.6

4 bar 3.2 0.8

PpN2 PpO2

5 bar 4.0 1.0


Decompression IllnessDecompression Illness


Decompression IllnessDecompression Illness

8

DCIDCIDecompression IllnessDecompression Illness

Burst LungBurst Lung

refers to lung over-expansion Injuries

DCSDCSDecompression SicknessDecompression Sickness

refers to the conditions caused by inert nitrogen gas coming out of

solution within the body


DCS: SummaryDCS: Summary

• The deeper the dive - the more gas is absorbedThe deeper the dive - the more gas is absorbed

• The longer the diver is at pressure - the more gas will The longer the diver is at pressure - the more gas will diffuse into the tissues diffuse into the tissues

• If pressure is removed too rapidly: Gas expands & comes If pressure is removed too rapidly: Gas expands & comes out of solution, forms bubblesout of solution, forms bubbles

• Onset: 50% within 1 hour - 90% within 6 hoursOnset: 50% within 1 hour - 90% within 6 hours

• Symptoms vary: Skin rash … to … severe CNS bendSymptoms vary: Skin rash … to … severe CNS bend


SupersaturationSupersaturation

10

DepthSaturation Level of N2

0 M

10 M

20 M

30 M

Diver’s Level of N2

Supersaturated

Saturated

Undersaturated

ASCENT

Bubbling Out


Decompression SicknessDecompression Sickness

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CONTRIBUTING FACTORSCONTRIBUTING FACTORS

• Shortened / omitted decompressionShortened / omitted decompression• Rapid ascent / loss of buoyancyRapid ascent / loss of buoyancy• Dehydration / cold / exposureDehydration / cold / exposure• Age / overweight / fatigue / smoking / alcoholAge / overweight / fatigue / smoking / alcohol• Drugs - prescription or otherwiseDrugs - prescription or otherwise• Pre-existing medical conditions / Patent Foramen OvalePre-existing medical conditions / Patent Foramen Ovale• Heavy exerciseHeavy exercise• Illness / injuriesIllness / injuries• Previous DCSPrevious DCS



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SYMPTOMSSYMPTOMS

• Generally unwell / Extreme fatigue Generally unwell / Extreme fatigue • Skin itching / Shortness of breathSkin itching / Shortness of breath• Pain in the limbs and joints / pins & needles / loss of sensationPain in the limbs and joints / pins & needles / loss of sensation• Dizziness / visual disturbance / Dizziness / visual disturbance / • Muscle weakness / loss of sensationMuscle weakness / loss of sensation• Inability to control bowel or bladder functionsInability to control bowel or bladder functions• Confusion / disorientationConfusion / disorientation

SIGNSSIGNS

•A blotchy, mottled, red rash on skin A blotchy, mottled, red rash on skin •Loss of power leading to paralysisLoss of power leading to paralysis•Staggering / loss of balanceStaggering / loss of balance•Choking / shortness of breath / ItchingChoking / shortness of breath / Itching•Collapse or unconsciousnessCollapse or unconsciousness



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TREATMENTTREATMENT

• 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 !


Handover to EMS Handover to EMS

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Entonox absolutely contraindicated

This slide for info only:

PHECC Clinical Practice Guidelines

[CPG]Decompression Illness

(DCI)

For use by trained:

•EMT•PARAMEDIC•ADVANCED PARAMEDIC


PulmonaryPulmonaryBarotraumaBarotrauma


Effect of Boyle’s lawEffect of Boyle’s law

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30 metres - 4 bar absolute30 metres - 4 bar absolute



SurfaceSurface



Pulmonary BarotraumaPulmonary Barotrauma

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BURST LUNGBURST LUNG

• Excess air pressure in the lungs (usually from not exhaling Excess air pressure in the lungs (usually from not exhaling properly on ascent)properly on ascent)• over-expands the lungover-expands the lung• the lung rupturesthe lung ruptures

SEVERAL CONDITIONS MIGHT ARISE ........SEVERAL CONDITIONS MIGHT ARISE ........

• Air embolism (Arterial gas embolism)Air embolism (Arterial gas embolism)• PneumothoraxPneumothorax• Mediastinal emphysemaMediastinal emphysema• Subcutaneous emphysemaSubcutaneous emphysema


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PneumothoraxPneumothoraxAir escaping into the Air escaping into the Pleural cavity causes Pleural cavity causes the lung to collapsethe lung to collapse

Arterial Gas EmbolismArterial Gas EmbolismBubbles of AirBubbles of Air

entering the Blood Vesselsentering the Blood VesselsBubbles inBubbles in

Carotid ArteryCarotid Arteryleading to Brainleading to Brain

Ruptured Alveoli and Blood VesselsRuptured Alveoli and Blood Vessels

Mediastinal EmphysemaMediastinal EmphysemaAir escaping into Air escaping into

thetheMediastinum Mediastinum

causescausescompression of thecompression of the

heart and lungsheart and lungs

Subcutaneous EmphysemaSubcutaneous EmphysemaAir from Mediastinum Air from Mediastinum collects under skin of collects under skin of neck compressing the neck compressing the

TracheaTrachea



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SYMPTOMSSYMPTOMS

• Onset usually on surfacingOnset usually on surfacing• Chest pain / shortness of breathChest pain / shortness of breath• Dizziness / visual blurringDizziness / visual blurring• WeaknessWeakness

SIGNSSIGNS

• Breathing - Difficult - rapid – shallow – absentBreathing - Difficult - rapid – shallow – absent• Swelling of the neck / Crackling sound / feeling around the neckSwelling of the neck / Crackling sound / feeling around the neck• Paralysis or weakness of the limbsParalysis or weakness of the limbs• Cough / Cyanosis; blue lips, fingertipsCough / Cyanosis; blue lips, fingertips• Change in voiceChange in voice• Convulsions ..... UnconsciousnessConvulsions ..... Unconsciousness



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TreatmentTreatment

•Immediate RecompressionImmediate Recompression

•Monitor A, B, C / 100% oxygen / Alert EMSMonitor A, B, C / 100% oxygen / Alert EMS•No food or fluidsNo food or fluids•If injuries permit; comfortable positionIf injuries permit; comfortable position•Keep victim at a comfortable temperatureKeep victim at a comfortable temperature•Check for bleeding and other injuriesCheck for bleeding and other injuries•Recognise and treat for shockRecognise and treat for shock


ReadingReading• CFT Trainee + Club CFT Trainee + Club

Diver Course MaterialsDiver Course Materials

• DDRC Underwater DDRC Underwater Diving Accident ManualDiving Accident Manual– Ignore pages 13-15Ignore pages 13-15– CFT DFR course does not CFT DFR course does not

currently teach currently teach • ‘‘Five Minute Neuro Exam’Five Minute Neuro Exam’


Module B: Diving Emergencies 1Module B: Diving Emergencies 1BarotraumaBarotrauma

• Has covered:Has covered:– Overview - Physics and physiologyOverview - Physics and physiology– Emergency care of Decompression Illness (DCI)Emergency care of Decompression Illness (DCI)

• Decompression SicknessDecompression Sickness• Pulmonary Barotrauma (Burst Lung)Pulmonary Barotrauma (Burst Lung)

• Closing StatementClosing StatementEffective first response followed by prompt treatment by Effective first response followed by prompt treatment by

the emergency services, usually with recompression, is the emergency services, usually with recompression, is necessary to treat barotrauma incidentsnecessary to treat barotrauma incidents


diver first responder (dfr) module b: diving emergencies 1 barotrauma dfr jan 2011: module b: emerg...

Documents

responder dfr module

decompression illness

bar dfr

barotrauma dfr

body dfr

bodydcs decompression

forms bubblesif pressure

inert nitrogen gas