What are the two DMO/UMO Sub-specialty codes assigned that allow for modifications to Treatments?
16U0 and 16U1 sub-specialty codes allow for the modification of Treatments.
What Treatment Table is used for deep uncontrolled ascent and HeO2 Blow-Up?
Treatment Table 8 is the table used to treat deep, uncontrolled ascents and HeO2 Blow-Up.
How do you treat a patient with Type I symptoms during the surface interval of a Sur 'D' O2 Dive?
If Type I symptoms resolve during the 15 minute 50-fsw stop, the surface interval was 5 minutes or less, and no neurological signs are found, increase the 50 fsw oxygen time from 15 to 30 minutes then continue normal decompression for the schedule of the dive. If Symptoms Persist, compress the Diver to 60 FSW and begin a table if 2 O2 Periods or less were required. Treat on table 6 if 2.5 or more O2 Periods were required.
List the Available Treatment tables at 87 degrees.
Available treatment tables for 87 degrees: TT5, 6, 6A, 1A, and 9.
What are the available treatments at 96 degrees?
Treatment Tables 5 and 9 are available to use at a temperature of 96 degrees.
What is the start depth for Treatment Table 7? What is the Minimum time spent at that depth?
Table 7 Start depth is 60 FSW with a minimum of 12 hours spent at that depth.
What type of patients are a Treatment Table 7 to be used on?
Only use a Table 7 when there is a possible loss of life.
The Trigeminal nerve governs facial sensation, the muscles of chewing and mastication.
What does the Abducens Cranial nerve govern?
The Abducens nerve governs Lateral movement of the eye.
What does the Facial Cranial Nerve Govern?
The Facial Nerve Governs the movement of the Face
What does the auditory cranial nerve govern?
The Auditory Nerve governs the ability to hear and the patient's sense of balance.
What does the Glossopharyngeal cranial nerve govern?
The Glosopharyngeal governs the gagging response.
What does the Vagus Cranial nerve Govern?
The Vagus nerve governs the roof of the mouth and the vocal chords.
What does the Spinal Accessory Nerve Govern?
The Spinal Accessory governs the ability to turn the head from side to side and the ability to shrug.
What does the Hypoglossal Cranial Nerve Govern?
The Hypoglossal Nerve governs the movement of the tongue.
How do you treat Symptomatic Omitted 'D'?
TT6 or TT6A can be used to treat Symptomatic Omitted 'D'
Explain what Tribonucleation is.
Bubbles areCreated when Two Surfaces in a viscous liquid are rapidly separated or moved relative to each other. an Example would be Joints cracking (collapse of the bubbles).
What are the four types of POIS?
Mediastinal Emphysema, Subcutaneous Emphysema, Pneumothorax, Arterial Gas Embolism are examples of Pulmonary Overinflation Syndrome
What are the two types of Pneumothorax?
A General Pneumothorax is when Gas is trapped in the pleural space between the lung and the chest wall. A Tension Pneumothorax is when the damaged lung allows gas to enter the space continually, enlarging the pocket.
What are the symptoms of CNS O2 Toxicity?
Visual Distortions Ears are Ringing or Roaring Numbness Tingling Irritability Dizziness Convulsion
How do you treat a Non-Convulsive CNS O2 Tox Symptom?
Remove O2 Wait for Symptoms to Subside After :15, resume at point of interruption
What if the first CNS O2 Toxicity Symptom is a convulsion?
Remove O2 After all symptoms have subsided, decompress ten feet at a rate of one foot per minute. Only begin travelling when the patient is fully relaxed and breathing normally.
What are the causes and hallmark symptoms of Hypercapnia?
CO2 Absorbent failure, Overbreathing rig, improper line up, inadequate ventilation, are several causes of Hypercapnia. Heavy Breathing, tachycardia, and headache are common symptoms of Hypercapnia.
What are the causes and hallmark symptoms of Hypoxia?
Not enough O2, Bad Rig Line up, Contaminated Gas Source, are several causes of Hypoxia. Common symptoms include drowsiness, weakness, euphoria, and loss of consciousness.
What are the causes and hallmark symptoms of CO poisoning?
Bad Gas: caused by a compressor's intake too close to the exhaust would introduce CO into breathing media. A Victim of CO Poisoning may notice headache, confusion, vomiting or tightness across the forehead.
What are the causes and hallmark symptoms of Cardiopulmonary DCS?
Chokes is generally caused by a deep, uncontrolled ascent to the surface. Chokes can be characterized by a bloody and frothy cough.
What are the causes and hallmark symptoms of Inner Ear Barotrauma?
Inner Ear Barotrauma is caused by pressure imbalances in the middle ear, or middle ear barotrauma. Symptoms of Inner ear Barotrauma may include persistent vertigo and hearing loss, and nausea and vomiting.
Explain Bernoulli's Principle.
Bernoulli's Principle describes that when a liquid encounters an obstruction or constriction in a tube causing it to accelerate creates a reduction in pressure, i.e. turbulence. (Think rapids in a river).
Where did the Bend's get its name?
What is perfusion?
Perfusion is blood flow.
What is diffusion?
Think of Diffusion as equalization based on the weight of a gas. Supersaturation due to a lighter gas moving into tissue faster than a heavier gas can move out.
Describe several symptoms of Spinal Cord DCS.
Pain will radiate around the torso. Pain may be dull or lancing. Pain in the hip may also be due to Spinal Cord DCS.
Describe the Pain Scale.
0= Paralysis- no movement at all 1= Profound weakness- flicker or trace of muscle contraction 2= Severe Weakness- able to contract muscle, but cannot move against gravity 3= Moderate weakness- able to overcome force of gravity, but not the examiner 4= Mild Weakness- able to resist slight force of examiner. 5= Normal Strength
What Alphabetical Letters do you use to geta patient to describe pain to you?
Alert and Oriented times 3. Patient should be aware of their person, place, and time.
What Cranial Nerve tests the chewing Muscles?
The Trigeminal nerve governs the chewing muscles.
What Cranial Nerve Tests Facial Sensation?
The Trigeminal Nerve covers facial sensation.
About how long is a TT5?
A treatment Table 5 runs for about two hours and fifteen minutes.
How long must a tender breathe O2 if they have sat for the entire table?
Tender breathes O2 during the last 30' stop to the surface. If previous Hyperbarics in the last 18 hours, an additional 20 minutes is required.
About how Long is a Table 6?
A Table 6 runs for about 4 hours and 45 minutes.
How long must a tender breathe O2 if they have sat for the whole of Treatment Table 6?
Inside Tender breathes O2 during the last 30 minutes at 30 FSW and during ascent. If there has been more than one extension, tender must breathe 60 minutes of O2 at 30 FSW. If there has been a previous Hyperbaric Exposure in the past 18 hours, tender is required to breathe an additional 60 minutes of O2 at 30 FSW.
A Patient can sleep on O2 no deeper than what depth?
A Patient can sleep while on O2 if he is at 30 FSW or shallower.
If a Patient has symptoms of Pulmonary O2 Toxicity, what can be done for them?
If a patient is experiencing symptoms of Pulmonary O2 Toxicity, the O2 can be humidified or shorter O2 periods can be used. Consulting a DMO is always a priority.
If a patient has a recurrence of symptoms in the chamber during treatment, shallower than 60 FSW, what is the first step in the protocol?
First step if there is a recurrence of symptoms shallower than 60 FSW is to return to 60 FSW.
What treatment table is used for loss of O2, greater than 2 hours, on a treatment table where an increase in depth deeper than 60 FSW is needed?
If O2 cannot be restored in two hours, and an increase in depth, deeper than 60 FSW is needed, use TT4. Consult DMO prior to committing to TT4.
What is the Importance of a Gag Valve?
To stop a relief valve.
What kind of mattress is used in the chamber?
Durrett Product or Submarine Mattress, enclosed in flameproof covers.
What are the normal/acceptable levels for oxygen in the recompression chamber?
19-25% are the acceptable levels for O2 in the Chamber.
What is the Maximum acceptable level of CO2 at 30 FSW, 60 FSW, and 165 FSW?
The acceptable levels of CO2 in the Chamber must be: 30 FSW = .78% 60 FSW = .53% 165 FSW = .25%
What is the acceptable clothing for chamber occupants?
100% Cotton is preferred, although 65% Poly, 35% Cotton is Acceptable.
What NSTM covers lubricants for recompression chambers?
NSTM 262 covers Lubricants for recompression chambers.
What are the descent rates for all treatments?
20 FPM is the descent rate for all treatment tables.
who can modify treatment tables?
A DMO with a 16U0 or 16U1 Sub-Specialty code can modify treatment tables.
What are the diving supervisor's responsibilities to the Chamber Team?
The Diving Supervisor must be familiar with recompression procedures, know the location and how to get to the nearest recompression facility, how to contact a qualified DMO, and he must be trained in BCLS.
Where can a Dive SUpervisor call for EMergency consultation of a Patient?
If a DMO is unavailable, a Dive Supervisor may call NEDU or NDSTC.
What is the ACLS/BLS-D protocol for a diver without vitals?
If ACLS <:10 then keep the Patient at surface until a pulse is obtained. If ACLS >:10 then compress patient to 60' and continue CPR. If ACLS arrives within <:20 then bring patient to surface.
How would a Dive supervisor handle a case of CNS O2 Toxicity during a treatment?
1st Symptom: Off O2, Wait for Symptoms to subside, resume at point of interruption. 2nd Symptom/1st Convulsion: Off O2, Wait for Symptoms to subside, wait :15, when patient can breathe normally ascend 10' at 1 FPM.
When can Pulmonary O2 Toxicity Occur?
Pulmonary O2 Toxicity can occur during long treatments, during repetitive or consecutive treatments. Generally when breathing dry O2.
When is an Inside Tender Required to breathe O2 during a TT6?
The inside tender is required to breathe O2 during the last :30 at 30'. If there were any extensions, then the tender breathes :60. If the tender has had any hyperbarics in the last 18, then add :60 at 30'.
When is an Inside Tender required to breathe O2 during a TT6A?
The inside tender is required to breathe O2 during the last :60 at 30'. If there were any extensions then the tender breathes O2 for :90. If the tender has had any Hyperbarics in the last 18 hours, then add :60 at 30'.
What is the Inside Tender's Required Surface Interval Between treatments and diving?
For a No 'D' dive, the Tender must wait 18 hours. For a 'D' Dive, the Tender must wait 24 hours. For Treatment Tables 4, 7, and 8, the tender must wait 48 hours before any diving.
When can patients fly after treatments?
A Patient may fly after 72 Hours.
How would you treat Altitude DCS if only joint pain was present, but resolved prior to reaching 1 ata?
You would need to administer two hours of O2 followed by 24 hours of observation.
Which part of the Neurological Exam do you ask the patient about their Dive Profile?
When you cover History.
What is the Treatment depth of TT1A?
Treatment Depth for TT1A is 100'
What is the treatment depth of a TT2A?
Treatment Depth for a TT2A is 165'
What are the indications for each air treatment table?
TT1A: Pain only Symptoms releived at depth <66 FSW. TT2A: Pain Only Symptoms relieved at depth >66 FSW. TT3: Serious DCS or AGE Symptoms relieved in :30, otherwise switch to TT4. TT4: Serious DCS and AGE Symptoms relieved >30 at 165 FSW.
Are there any extensions to air treatment tables?
No, there are no extensions to Air Treatment Tables.
What is the treatment for Symptomatic Omitted Decompression?
<50' Compress to 60' and begin TT6. >50' Compress to 60' or Depth of Relief not to exceed 165' and begin TT6A. Uncontrolled from >165' then compress to depth of relief not to exceed 225' using TT8.
What is the treatment for recurrence of symptoms?
For recurring symptoms, use the same table (unless it was table 5). DMO may elect TT9.
What must you ensure happens while transporting a patient to a recompression facility?
Ensure The patient is comfortable or lying down (supine). Administer O2 Check Vitals frequently. Hydration Warmth
What procedure must you employ if you lose O2 during a treatment?
<:15 resume at point of interruption :120>:15 Complete table with Max Extensions >:120 Switch to a compatible Air Table
What are Five things that may produce unconsciousness?
Hypoxia Hypercapnia DCS AGE CNS O2 Toxicity
What tables can you use to treat residual symtoms?
You can use TT9 (prescribed by DMO), TT5 or TT6 to treat residual symptoms.
What are the indications for using a TT6A?
If you have unchanged or worsening symptoms of AGE/DCS within :20 at 60 FSW. Asymptomatic Omitted Decompression. Symptomatic OmittedDecompression.
What are the indications for using a TT6?
If you have recurrence of symptoms shallower than 60 FSW. Treatment of unresolved symptoms (even type I DCS) following in-water recompression. AGE Type II Symptoms Type I Symptoms not relieved within :10 When a neuro cannot be done Cutis Marmorata Asymptomatic Omitted Decompression. Symptomatic OmittedDecompression. Symptomatic/Asymptomatic Exceeded Sur 'D' Interval
If on a TT5, when are you required to switch to a TT6?
If complete relief is not obtained within :10 of reaching 60' If a full neuro cannot be completed. Recurring type I symptoms.
When is a tender required to breath O2 during a TT5?
Tender is required to breathe O2 from the 30' stop to the surface.
When is a tender required to breathe O2 during a TT5 if he has had previous HBO exposure within 18 hours?
The Tender must breathe O2 for an additional :20 prior to ascent.
During a TT6, when is the Inside tender required to breathe O2?
During a TT6, The Inside Tender is required to breathe O2 during the last :30 at 30' plus ascent to the surface.
When is a tender required to breathe O2 during a TT6 if he has had previous HBO within past 18 hours?
The Inside Tender is required to breathe O2 for an additional :60 at 30 FSW.
How long must a tender Breathe O2 on a TT6 if there were extensions?
If there was 1 extension or less, tender breathes last :30. If there have been 2 or more extensions, tender breathes last :60.
What are the Inside Tender Extension obligations for a TT6A?
If there is 2 or more extensions, tender breathes all :90 of last O2 period. Otherwise, tender breathes O2 during last :60 of O2 Period.
When Do you need to vent if you have a CO2 and O2 Monitor?
You only need to vent as needed.
What flow rate should you vent if you have divers on an air break, with 2 patients and 1 tender on chamber air?
The Chamber should be vented for 8 ACFM. 2 Patients at rest count for 2 ACFM each and the active tender counts for 4 ACFM.
What flow rate should be used if you have a BIBS dump system, 2 patients on O2, and 1 tender on air?
The chamber should be vented for 4 ACFM. The 2 patients do not exhaust O2 into the Chamber Atmosphere, so only the tender breathing chamber air, needs to be vented for.
What flow rate should you use to vent a chamber that has Closed Circuit BIBS, 1 patient on O2 and two tenders on Chamber Air?
The chamber should be vented for 8 ACFM. The Closed circuit BIBS does not exhaust into the chamber atmosphere so only the two active tenders breathing chamber air need to be vented for at 4 ACFM each.
What flow rate should you use to vent a chamber that has no BIBS Dump, 2 Patients on O2 BIBS, and 2 Tenders on chamber air.
The chamber should be vented for 25 ACFM. Because there is no BIBS dump, each patient on O2 requires 12.5 ACFM as they are exhausting O2 into the Chamber atmosphere. The tenders are not accounted for.
What flow rate should you use if you have a chamber without BIBS dump, 2 patients on O2 BIBS, 1 tender on O2 BIBS, and 1 Tender on Chamber Air?
The chamber should be vented for 37.5 ACFM. Only the 2 patients and the tender need to be accounted for. 12.5 ACFM for each patient and 12.5 ACFM for the tender who should also be at rest (because he's on O2).
What are the procedures for a 1st CNS O2 Toxicity Symptom that is non-convulsive.
Off O2. Wait for :15 after symptoms subside and then resume at Point of Interruption.
What procedure do you use if you have permanent loss of O2 during a TT6A?
For a Permanent Loss of O2, you switch to a compatible Air Table after consulting with a qualified DMO.
What procedure do you use if you lose Oxygen for :120>:15?
If you lose Oxygen for greater than Fifteen Minutes,but less than two hours, you maximize your extensions for that table.
What treatment tables are allowed if you have an internal chamber temperature of 96 degrees?
You are allowed to use Treatment tables 5 and 9 if you have temperatures greater than 95 but less than 104.
For Symptomatic, uncontrolled Ascent from < 50 FSW?
Press patient down to 60 FSW and treat on Table 6.
For Symptomatic, unctonrolled Ascent from >50 FSW?
Press patient down to 60 FSW or depth of significant relief not to exceed 165 FSW and begin TT6A.
How soon after treatment for DCS type I can a patient return to diving duty after being cleared by a DMO?
Seven Days are required before the patient can return to diving duty.
How Soon should ACLS/AED Arrive before compressing a Pulseless diver?
ACLS/AED should arrive within :10.
How Deep can a patient sleep on O2?
A Patient can sleep while on O2 No Deeper than 30'
What are the limits for O2 and CO2 in the chamber?
<1.5% SEV for CO2 19-25% for O2.
What is the limit for CO2 at 30 FSW?
The limit for CO2 at 30' is .78%
What is the limit for CO2 at 60 FSW?
The limit for CO2 at 60' is .53%
What is the Limit for CO2 at 165 FSW?
The Limit for CO2 at 165' is .25%
How long must Tenders stay at the Chamber Facility After a Treatment?
Tenders are required to stay the chamber facility for 1 hour. For TT-4,7, or 8, tender must be within one hour of facility for 24 hours.
How long is a patient required to be at a chamber facility after a treatment?
Patients from a TT-5 must remain at the facility for a minimum of two hours. Patients from a TT-6 must remain at the facility for a minimum of 6 hours. All other tables may require a period of hospitalization.
After TT5, how long must tenders wait before returning to diving?
For a TT-5, Tenders must wait 18 hours for a No 'D' Dive, and 24 hours for a 'D' Dive.
After a Treatment Table 4 or 7, how long must tenders wait before returning to diving?
For a TT-4 or 7, tenders must wait 72 hours before returning to diving.
Bladder Shock is a risk when removing what amount of fluid?
Bladder shock can happen if you have removed more than 1000cc of fluid.
A diver surfaces unconscious from a blow up of 50' or greater should be treated on on what minimum treatment Table?
TT6 Should be used at a minimum to treat a blow up from 50' or greater.
Recurrence of Type I Symptom during a treatment table 5 at 30' in the chamber should be treated how?
Recompress patient to 60' and begin a TT6.
After a Treatment Table 5, how long are patients required to stay at the chamber facility?
Patients are required to stay at the facility for 2 hours after being treated on a TT5.
After a Treatment Table 6, for type I symptoms, how long are patients required to stay at the chamber facility?
Patients are required to stay at the facility for a minimum of 6 hours after being treated on a TT6 for Type I symptoms.
Briefly Describe Isobaric Counterdiffusion.
It is DCS caused by a lighter gas displacing a heavier gas to quickly.
How long must a pressure test candidate wait for "Clean Time"?
A pressure test candidate must wait at least :15 for Clean Time.
When a patient can contract a muscle fully, but not overcome the force of gravity, what number is assigned to the weakness and what word is used to describe it?
When a patient can contract his muscle, but cannot overcome the force of gravity, he has Severe Weakness and this is abreviated with the number 2.
Is there an Antivenin for Stingray Stings?
No there isn't an Antivenin available for Stingray stings.
Is there an Antivenin for Box Jellyfish Stingray stings?
Yes, an Antivenin is available for Box Jellyfish Stings.
What is the most effective treatment for an unknown species of jellyfish stings, to neutralize nematocysts?
Vinegar is the most effective solution to neutralize Jelly Fish Stings.
Who is responsible for the Theory of Tissue Half-Times?
John Scott Haldane is responsible for the theory of Tissue Half-Times regarding decompression.
Who is responsible for Stage Decompression Theory?
John Scott Haldane is responsible for Stage Decompression theory.
What bubble theory describes a liquid encountering "Cheeseburger," obstructions and the resulting pressure changes that result in low pressure and bubble formations?
Bernoulli's Principle Describes bubbles encountering an obstruction causing high pressure around one side of the obstruction and low pressure on the other. This low pressure side is a prime area for bubble formations.
What is a Direct Bubble Effect?
a Direct Bubble Effect is the obstruction of blood.
What is an indirect Bubble Effect?
An Indirect Bubble Effect is what happens after blood flow has stopped. Hypoxia to the surrounding tissues, pain and swelling due to edema that is caused by the vessel breaking.
A Patient on a 140/:15 dive, with several minutes of missed decompression and complaints of pain radiating around the chest should be considered for what diagnosis and treatment?
The patient is suffering from a Type II Symptom and should be treated on a TT6A.
A Patient who can resist slight resistance from the examiner has weakness of what scale from 0 to 5? What word is used to describe this weakness?
A patient who cannot resist the examiner, but can contract his muscle fully, is considered to be Moderately Weak, this is denoted with a 3.
A Patient with several days of Diving MK-25, with burning pain on inspiration and a dry cough should be considered to have what illness?
This patient is most likely suffering from Pulmonary O2 Toxicity.
What is the name of the test of coordination that describes a patient with feet together, arms extended and palms up?
The name of this Coordination test is called the Romberg Test.
What type of symptoms should a patient have before consideration of a TT7?
A patient is probably suffering from Severe Gas Embolism or Life-Threatening DCS if there is consideration of using a TT7.
What action should be taken for a TT6, if oxygen is lost for :42?
You should maximize extensions when you lose O2 for greater than :15 and less than 2 hours.
What action should be taken for a TT4 if O2 is lost for :16?
No corrective action is required if you lose O2 on a TT4.
How can breathing periods be modified on a TT4 if oxygen cannot be tolerated?
After consultation with a DMO, Breathing periods can be divided into smaller intervals such as :15 O2 Periods.
How long should a patient be oxygenated with a Bag Valve Mask before attempting intubation?
A patient should be oxygenated for at least :03 before attempting intubation.
How long should an intubation attempt last before oxygenation needs to be continued.
an Intubation attempt should last no more than ::30 seconds.
Is Recompression a higher priority than ACLS in a pulseless diver with no respirations?
No. ACLS is a higher priority for a pulseless diver.
How long should you wait for a defibrillator before compressing a pulseless diver?
If a Defibrillator is within :10, the stricken diver should be kept on surface. Otherwise recompress the diver to 60' and continue CPR.
Which Nerve controls Pupil Dilation?
the Optic Nerve governs the recognition of light and shade and the perception of objects.
Which nerve controls facial sensation?
The Trigeminal nerve governs the sensation of the face and forehead as well as the clenching of the jaw.
Describe tender O2 breathing requirements for a tender on a TT6A with two extensions and previous dives in the last 18 hours.
If there has been more than one extension, the O2 Breathing at 30 FSW is increased to :90. If the tender had a hyperbaric exposure within the past 18 hours, an additional :60 O2 period is taken at 30 FSW.
What are the Tender O2 Obligations for a TT6?
If there has been more than one extension, the tender is required to breath O2 for an additional :60 at 30 FSW. If the tender had previous hyperbaric exposure within the last 18 hours, an additional :60 of O2 time is required at 30 FSW.
What are the extensions for a TT6?
TT6 can be lengthened up to two additional :25 Periods at 60 FSW, or up to two additional :75 periods at 30 FSW, or both.
What are the extensions for a TT6A?
TT6A can be lengthened up to two additional :25 periods at 60 FSW, or up to two additional :75 periods at 30 FSW, or both.
What are the Tender O2 Breathing Obligations for a TT9?
Tender brreathes O2 during last :15 at 45 FSW and during ascent.
What are the extensions for a TT5?
TT5 may be extended by two oxygen periods at the 30 FSW stop.
What are the tender O2 breathing requirements on a TT5?
Tender breathes O2 during ascent from 30 FSW stop. If tender had a previous hyperbaric exposure in past 18, an additional :20 of O2 is required prior to ascent.