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Pressure Laws. Boyle's law: PV=KAs pressure ?, volume ?As pressure ?, volume ?Dalton's law: Pt = P02 PN2 PxTotal pressure of gas mixture is sum of partial pressures of its componentsHenry's law: Pressure of a gas in liquid is proportional to its pressure in the atmosphere. Barotrauma. Injury caused by compression or expansion of gas in body spaces.
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1. Diving Emergencies
3. Barotrauma Injury caused by compression or expansion of gas in body spaces
4. Barotrauma Ear squeeze
Sinus squeeze
Lung trauma (pulmonary overpressure)
Arterial air embolism
5. Ear Squeeze Pressure does not equalize in middle ear through Eustachian tube
Common when diving with URI
Severe pain
Potential for ear drum rupture
Water enters middle ear; vertigo/incapacitation
6. Sinus Squeeze Pressure does not equalize in frontal or maxillary sinus
Common when diving with URI
Severe pain
7. Lung Trauma Pulmonary Overpressure Syndrome (POPS)
Breath-holding during ascent
Compressed air in lungs expands
Lung tissue ruptures, resulting in:
Pneumothorax/tension pneumothorax
Pneumomediastinum
Subcutaneous emphysema
Arterial air embolism
8. Lung Trauma May occur in shallow depths
Signs/Symptoms
Respiratory distress
Substernal chest pain
Diminished breath sounds
Treatment
Rest
Oxygen
Treat pneumothorax
9. Arterial Air Embolism Caused by breath-holding during ascent
Lung tissue tears/air enters pulmonary circulation
Air enters left heart, is pumped to systemic circulation
Air bubbles enter, clog cerebral circulation
10. Arterial Air Embolism Rapid onset of:
Alterations in consciousness—usually within 10 minutes
Hemiplegia
Unequal pupils
Cardiopulmonary failure
Vertigo
Visual disturbances
11. Arterial Air Embolism Management
ABC’s
100% oxygen, assist ventilations as needed
Supine (Left side 300 head down)
IV with NS, LR
Transport to decompression chamber
Steroids on medical control orders
12. Decompression Sickness
13. Decompression Sickness Diver breathes compressed air
Nitrogen dissolves in blood
Diver does not surface at correct rate to allow nitrogen to escape from blood
Nitrogen bubbles form in tissue, small blood vessels
Occludes circulation in small vessels
14. Decompression Sickness Cutaneous bends
Itching
Mottled rash
15. Decompression Sickness Musculoskeletal DCS (“Bends”)
“Dull ache” in muscles/joints
Movement worsens pain
Fatigue
Inflating BP cuff over area relieves pain
16. Decompression Sickness Central nervous system DCS
Brain involvement
CVA like symptoms
Paresthesias
“Staggers”
Spinal cord involvement
Paralysis
17. Decompression Sickness Pulmonary DCS --“Chokes”
Chest pain
Cough
Dyspnea
Pulmonary edema
18. DCS Management ABC’s
100% Oxygen
IV with LR
Lateral recumbent position if air embolism suspected
Transport to recompression chamber
Steroids on Medical Control orders
19. Nitrogen Narcosis “Rapture of the Deep”
Pressurized nitrogen toxic effects on CNS
Anesthetic effect due to lipid solubility of N2
Result is intoxication
Other injury may result from impaired judgment
Affects most divers to some degree
Usually on dives 70-100 feet
20. Nitrogen Narcosis Signs and Symptoms
Euphoria
Confusion
Disorientation
Slowed motor response
Treatment
Surfacing corrects problem
Consider possibility of CO toxicity
21. Diving Incident Assessment When was last dive?
How many dives that day?
What depths?
Did diver ascend quickly? Why?
Did diver make decompression stops during ascent?
Symptoms? Onset of symptoms?
Diver’s appearance immediately after dive?
22. Diver’s Alert Network (919) 684-8111 (emergency)
www.diversalertnetwork.org
(919) 684-2948 (non-emergency)