Download - Diver First Responder (DFR) Module C: Diving Emergencies 2 Non-Pressure Related Emergencies.

Diver First Responder Diver First Responder (DFR)(DFR)

Module C: Diving Emergencies 2Module C: Diving Emergencies 2Non-Pressure Related EmergenciesNon-Pressure Related Emergencies

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 C: EMERG 2

In Module C: we will CoverIn Module C: we will Cover

Non-Pressure Related EmergenciesNon-Pressure Related Emergencies

• Dive Site Accident Management• Gas toxicity• Near drowning• Minor barotrauma• Good diving practise


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


Dive SiteDive SiteAccident ManagementAccident Management

DFR JAN 2011: MODULE C: EMERG 2

Dive Site Accident ManagementDive Site Accident Management

• Be aware of all symptoms• An unwell diver should exit the water• Presume illness is dive-related• Have 02 and emergency kit to hand• Alert Emergency Medical Services (EMS)

(Dial 999 or 112)


Treatment of the Injured or Ill DiverTreatment of the Injured or Ill Diver• Get diver back on boat or ashore • If altered consciousness on surfacing, ensure jacket

inflated & weights removed • Loosen tight clothing• History / examination – Symptoms / signs• What is the key problem /condition …?• Monitor A-B-C / Administer 100% oxygen• Alert EMS


Role of Cox’n in an EmergencyRole of Cox’n in an Emergency

• Ensure VHF radio is working• Ensure EMS is alerted• Know your exact position• Follow instructions of EMS• Ensure a record is kept


Gas ToxicityGas ToxicityOxygen (0Oxygen (022))

Nitrogen (NNitrogen (N22))

Carbon Dioxide (C0Carbon Dioxide (C022))

Carbon Monoxide (CO)Carbon Monoxide (CO)


Oxygen (0Oxygen (022) Toxicity (hyperoxia)) Toxicity (hyperoxia)


• Oxygen at partial pressure >1.6 bar Oxygen at partial pressure >1.6 bar is toxicis toxic

• Poisonous to various body tissues - Poisonous to various body tissues - especially the brain and nervous especially the brain and nervous tissuestissues

• First Aid OFirst Aid O22 delivered at 1 bar is safe delivered at 1 bar is safe


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SYMPTOMS (CONVENTID)CONVENTID)

CONCON ConvulsionsConvulsionsVV Visual disturbances/Tunnel visionVisual disturbances/Tunnel visionEE Ears ringing (Tinnitus)Ears ringing (Tinnitus)NN NauseaNauseaTT Tingling or twitching (facial)Tingling or twitching (facial)II IrritabilityIrritabilityDD Dizziness or vertigoDizziness or vertigo

SIGNS (TWO PHASES)

•Tonic phase: Tonic phase: the muscles “tone” or stiffenthe muscles “tone” or stiffen•Clonic phase: Clonic phase: the muscles start to jerkthe muscles start to jerk



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Treatment Underwater

•Provide breathing gas with correct PpO2

•Bring to the surface•Attempt lift after ‘Tonic’ phase has passed

Treatment On Surface

•Monitor ABC / Administer 100% oxygen•Alert Emergency Medical Services (EMS)


Nitrogen (NNitrogen (N22) Narcosis) Narcosis

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Increased ppN2 causes a form of ‘narcosis’ or intoxication

Symptoms

•Elation / false sense of well-being / sight and sound altered•Feeling of unease, panic/fear

Signs

•Unusual behaviour / Loss of judgement and dexterity•Panic / stupor and/or unconsciousness•Diver’s subsequent actions may lead to injury or drowning

Treatment

•Ascend to a shallower depth – or to the surface if necessary


Carbon Monoxide (CO) ToxicityCarbon Monoxide (CO) Toxicity

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• Colourless, tasteless, odourless, non-irritating gasColourless, tasteless, odourless, non-irritating gas

• Produced when carbon is incompletely burned; fuels such Produced when carbon is incompletely burned; fuels such as wood, petrol or dieselas wood, petrol or diesel

• Enters through lungs; delivered to bloodEnters through lungs; delivered to blood

• Red blood cells pick up CO instead of oxygenRed blood cells pick up CO instead of oxygen

• Haemoglobin attracts CO 250 times more than oxygenHaemoglobin attracts CO 250 times more than oxygen • CO inhibits blood oxygenation and distribution to organsCO inhibits blood oxygenation and distribution to organs



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SYMPTOMS

•Breathlessness on exertion/ Fatigue, nausea headaches•Vertigo / noises in the ears•‘Pins and needles’ / confusion and disorientation

SIGNSSIGNS

•Loss of consciousness without warning / red lips•Respiratory arrest




TREATMENTTREATMENT

• Monitor ABC’s / 100% Oxygen / Contact EMS if Monitor ABC’s / 100% Oxygen / Contact EMS if necessarynecessary

• Monitor all divers who used same air sourceMonitor all divers who used same air source

• Retain cylinder for inspectionRetain cylinder for inspection

• Medical assessment and hyperbaric oxygenMedical assessment and hyperbaric oxygen

Carbon Dioxide Poisoning (Hypercapnia) Carbon Dioxide Poisoning (Hypercapnia) re-inhalation of C0re-inhalation of C022

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• CO2 is a natural by-product of metabolism• High concentrations of CO2 can displace oxygen in the air• Hypoxia may be combined with CO2 toxicity• Hypercapnia may exacerbate conditions: narcosis, Hypothermia, DCI

SYMPTOMS• Headache / confusion / disorientation / lethargy

SIGNS• Panic / hyperventilation / convulsions / unconsciousness

TREATMENT• Remove from source, i.e. surface / abort dive• Monitor ABC’s / Administer 100% oxygen / alert EMS0


Near DrowningNear Drowning



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Near drowning ......

..... the survival of a drowning event involving unconsciousness or water inhalation ......

..... can lead to serious secondary complications, including death, after the event ......

There may be deterioration later – important to closely monitor patient closely following event



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SYMPTOMS•Respiratory distress: cough, wheeze, shortness of breath

SIGNS•Altered consciousness / Cyanosis: Grey/blue skin•Froth around lips and nose•Respiratory arrest•Nothing initially…

TRETATMENT•Remove from water, discontinue activity, check for other injuries, keep warm•Monitor ABC’s / 100% oxygen / Alert EMS•Hospital for observation - ‘secondary drowning’


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Oxygen Therapy


This slide for info only:

PHECC Clinical Practice Guidelines

[CPG]SUBMERSION

INCIDENT (DCI)

For use by trained:

•EMT•PARAMEDIC•ADVANCED PARAMEDIC

Other Pressure Related IllnessOther Pressure Related Illness• DENTAL BAROTRAUMADENTAL BAROTRAUMA

– Loose fillings, badly fitting crown – pain on ascent / Loose fillings, badly fitting crown – pain on ascent / descentdescent

– Regular dental visits / check-upsRegular dental visits / check-ups

• EAR PROBLEMSEAR PROBLEMS– Caused by mucus build-up, cold, perforation in ear drumCaused by mucus build-up, cold, perforation in ear drum– Don’t dive if you have a cold/infectionDon’t dive if you have a cold/infection– Visit GP if problems persistVisit GP if problems persist


Prevention - Good Diving PractisePrevention - Good Diving Practise• DOD: dive planning

• Location/profile planned

• Maintain dive log

• Fly ‘A’ Diving Flag during dive

• Brief all re emergency procedures

• Monitor divers location throughout dive


Safety at SeaSafety at Sea

• Plan your dive – dive your plan• Tides / charts / weather• Contingency and emergency plans• First aid and oxygen kits• SMB’s / hi-visibility clothing / flares / lights• Whistles / sound generators• In an Emergency: Channel 16: Tel 999 or 112


Module C: Diving Emergencies 2Module C: Diving Emergencies 2Non-Pressure Related EmergenciesNon-Pressure Related Emergencies

• Has covered– Dive accident site management– Gas toxicity– Near drowning– Minor barotrauma– Prevention - good diving practise
