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Diver First Responder (DFR)

Diver First Responder (DFR). Module B: Diving Emergencies 1 DCI. DFR Course. DFR FEB 2012: MODULE B: EMERG 1. In Module B: We will Cover. Diving Emergencies 1 Overview - Physics and physiology Decompression Illness (DCI) Decompression Sickness Pulmonary Barotrauma (Burst Lung).

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Diver First Responder (DFR)

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  1. Diver First Responder(DFR) Module B: Diving Emergencies 1DCI

  2. DFR Course DFR FEB 2012: MODULE B: EMERG 1

  3. In Module B: We will Cover • Diving Emergencies 1 • Overview - Physics and physiology • Decompression Illness (DCI) • Decompression Sickness • Pulmonary Barotrauma (Burst Lung)

  4. Common Terminology

  5. Physics & Physiology Overview PRESSURE Atmospheric + Water pressure = Absolute Pressure 1 bar 2 bar 10 metres 1 bar

  6. 1 bar 0.8 0.2 2 bar 1.6 0.4 3 bar 2.4 0.6 4 bar 3.2 0.8 5 bar 4.0 1.0 Partial Pressures Absolute Pressure Depth PpN2 PpO2 0 10 m 20 m 30 m 40 m

  7. Decompression Illness

  8. Decompression Illness DCI Decompression Illness DCS Decompression Sickness refers to the conditions caused by inert nitrogen gas coming out of solution within the body Burst Lung refers to lung over-expansion Injuries

  9. DCS: Summary • The deeper the dive - the more gas is absorbed • The longer the diver is at pressure - the more gas will diffuse into the tissues • If pressure is removed too rapidly: • gas expands , comes out of solution and forms bubbles • Onset: 50% within 1 hour - 90% within 6 hours • Symptoms vary: Skin rash … to … severe CNS bend

  10. A S C E N T Supersaturation Saturation Level of N2 Diver’s Level of N2 Depth 0 M Bubbling Out 10 M Supersaturated 20 M Saturated 30 M Undersaturated

  11. Decompression Sickness • Contributing Factors • Shortened / omitted decompression • Rapid ascent / loss of buoyancy • Dehydration / cold / exposure • Age / overweight / fatigue / smoking / alcohol • Drugs - prescription or otherwise • Pre-existing medical conditions / Patent Foramen Ovale • Heavy exercise • Illness / injuries • Previous DCS

  12. Decompression Sickness • Symptoms • Generally unwell / Extreme fatigue • Skin itching / Shortness of breath • Pain in the limbs and joints / pins & needles / loss of sensation • Dizziness / visual disturbance • Muscle weakness / loss of sensation • Inability to control bowel or bladder functions • Confusion / disorientation • Signs • A blotchy, mottled, red rash on skin • Loss of power leading to paralysis • Staggering / loss of balance • Choking / shortness of breath / Itching • Collapse or unconsciousness

  13. Decompression Sickness • Treatment • 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 !

  14. Handover to EMS • This slide for info only: • PHECC Clinical Practice Guidelines • [CPG] • DECOMPRESSION ILLNESS (DCI) • For use by trained: • EMT • PARAMEDIC • ADVANCED PARAMEDIC

  15. PulmonaryBarotrauma

  16. Effect of Boyle’s law Surface 0 metres - 1 bar absolute 10 metres - 2 bar absolute 20 metres - 3 bar absolute 30 metres - 4 bar absolute

  17. Pulmonary Barotrauma • Burst Lungs • Excess air pressure in the lungs (usually from not exhaling properly on ascent) • Over-expands the lung • The lung ruptures • Several conditions might arise ... • Air embolism (Arterial Gas Embolism - AGE) • Pneumothorax • Mediastinal emphysema • Subcutaneous emphysema

  18. Subcutaneous Emphysema Pneumothorax Air escaping into the Pleural cavity causes the lung to collapse Air from Mediastinum collects under skin of neck compressing the Trachea Mediastinal Emphysema Arterial Gas Embolism Bubbles of Air entering the Blood Vessels Air escaping into the Mediastinum causes compression of the heart and lungs Bubbles in Carotid Artery leading to Brain Ruptured Alveoli and Blood Vessels

  19. Pulmonary Barotrauma • Symptoms • Onset usually on surfacing • Chest pain / shortness of breath • Dizziness / visual blurring • Weakness • Signs • Breathing - difficult - rapid – shallow – absent • Swelling of the neck / crackling sound/feeling around the neck • Paralysis or weakness of the limbs • Cough / cyanosis; blue lips, fingertips • Change in voice • Convulsions ..... Unconsciousness

  20. Pulmonary Barotrauma • Treatment • Monitor A, B, C / 100% oxygen / Alert EMS • No food or fluids • If injuries permit; comfortable position • Keep casualty at a comfortable temperature • Check for bleeding and other injuries • Recognise and treat for shock • Recompression may be required

  21. Reading • CFT Trainee + Club Diver Course Materials • DDRC Underwater Diving Accident Manual • Ignore pages 13-15 • CFT DFR course does not currently teach • ‘Five Minute Neuro Exam’ Out of Print CURRENTLY UNDER REVIEW

  22. Module B: Diving Emergencies 1Barotrauma • We have covered: • Overview - Physics and Physiology • Emergency care of Decompression Illness (DCI) • Decompression Sickness • Pulmonary Barotrauma (Burst Lung) • Closing Statement • Effective first response followed by prompt treatment by the emergency services, usually with recompression, is necessary to treat barotrauma incidents

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