Diver First Responder (DFR) Module B: Diving Emergencies 1 Barotrauma DFR JAN 2011: MODULE B: EMERG...
-
Upload
hadley-norman -
Category
Documents
-
view
218 -
download
0
Transcript of 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)
3DFR JAN 2011: MODULE B: EMERG 2
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
4DFR JAN 2011: MODULE B: EMERG 2
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
DFR JAN 2011: MODULE B: EMERG 2
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
6DFR JAN 2011: MODULE B: EMERG 2
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
DFR JAN 2011: MODULE B: EMERG 2
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
9DFR JAN 2011: MODULE B: EMERG 2
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
DFR JAN 2011: MODULE B: EMERG 2
Decompression SicknessDecompression Sickness
11
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
DFR JAN 2011: MODULE B: EMERG 2
Decompression SicknessDecompression Sickness
12
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
DFR JAN 2011: MODULE B: EMERG 2
Decompression SicknessDecompression Sickness
13
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 !
DFR JAN 2011: MODULE B: EMERG 2
Handover to EMS Handover to EMS
14
Entonox absolutely contraindicated
This slide for info only:
PHECC Clinical Practice Guidelines
[CPG]Decompression Illness
(DCI)
For use by trained:
•EMT•PARAMEDIC•ADVANCED PARAMEDIC
DFR JAN 2011: MODULE B: EMERG 2
Effect of Boyle’s lawEffect of Boyle’s law
17
30 metres - 4 bar absolute30 metres - 4 bar absolute
10 metres - 2 bar absolute10 metres - 2 bar absolute
20 metres - 3 bar absolute20 metres - 3 bar absolute
SurfaceSurface
0 metres - 1 bar absolute0 metres - 1 bar absolute
DFR JAN 2011: MODULE B: EMERG 2
Pulmonary BarotraumaPulmonary Barotrauma
18
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
DFR JAN 2011: MODULE B: EMERG 2
19
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
DFR JAN 2011: MODULE B: EMERG 2
Pulmonary BarotraumaPulmonary Barotrauma
20
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
DFR JAN 2011: MODULE B: EMERG 2
Pulmonary BarotraumaPulmonary Barotrauma
21
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
DFR JAN 2011: MODULE B: EMERG 2
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’
23DFR JAN 2011: MODULE B: EMERG 2
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
24DFR JAN 2011: MODULE B: EMERG 2