1. Diver First Responder (DFR) Module B: Diving Emergencies 1 Barotrauma DFR JAN 2011: MODULE B: EMERG 2

2. DFR Course ModuleTitleContent APHECC CFR CourseBasic Life Support & AED BDiving Emergencies 1Barotrauma CDiving Emergencies 2Non-Pressure Related Emergencies DDiving Emergencies 3Emergency Care EOxygen TreatmentTheory and Practice 2 DFR JAN 2011: MODULE B: EMERG 2

3. In Module B: We will Cover Diving Emergencies 1Diving Emergencies 1 –Overview - Physics and physiology Decompression Illness (DCI)Decompression Illness (DCI) –Decompression Sickness –Pulmonary Barotrauma (Burst Lung) 3 DFR JAN 2011: MODULE B: EMERG 2

4. Common Terminology TermDefinition IndicationUses for a medication / drug Contra-indicationCircumstances where a medication should not be given Medical EmergencyAcute injury or illness that poses an immediate risk to a person's life or long term health SymptomWhat the patient experiences SignWhat the care-giver sees 4 DFR JAN 2011: MODULE B: EMERG 2

5. PRESSUREAtmospheric+ Water pressure = Absolute Pressure PRESSUREAtmospheric+ Water pressure = Absolute Pressure Physics & Physiology Overview 5 2 bar 1 bar 10 metres 10 metres 1 bar 1 bar DFR JAN 2011: MODULE B: EMERG 2

6. Depth Absolute Pressure Partial Pressures 0 10 m 20 m 30 m 40 m 1 bar0.80.2 2 bar1.60.4 3 bar2.40.6 4 bar3.20.8 PpN 2 PpO 2 5 bar4.01.0 6 DFR JAN 2011: MODULE B: EMERG 2

7. Decompression Illness DFR JAN 2011: MODULE B: EMERG 2

8. Decompression Illness 8 DCI DCI Burst Lung refers to lung over-expansion Injuries Burst Lung refers to lung over-expansion InjuriesDCS Decompression Sickness refers to the conditions caused by inert nitrogen gas coming out of solution within the bodyDCS Decompression Sickness refers to the conditions caused by inert nitrogen gas coming out of solution within the body DFR JAN 2011: MODULE B: EMERG 2

9. DCS: 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 diffuse into the tissuesThe 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, forms bubblesIf pressure is removed too rapidly: Gas expands & comes out 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 9 DFR JAN 2011: MODULE B: EMERG 2

10. Supersaturation 10 Depth Saturation Level of N 2 0 M 10 M 20 M 30 M Diver’s Level of N 2 Supersaturated Saturated Undersaturated ASCENTASCENT Bubbling Out DFR JAN 2011: MODULE B: EMERG 2

11. Decompression Sickness 11 CONTRIBUTING FACTORS Shortened / omitted decompression Shortened / omitted decompression Rapid ascent / loss of buoyancy Rapid ascent / loss of buoyancy Dehydration / cold / exposure Dehydration / cold / exposure Age / overweight / fatigue / smoking / alcohol Age / overweight / fatigue / smoking / alcohol Drugs - prescription or otherwise Drugs - prescription or otherwise Pre-existing medical conditions / Patent Foramen Ovale Pre-existing medical conditions / Patent Foramen Ovale Heavy exercise Heavy exercise Illness / injuries Illness / injuries Previous DCS Previous DCS DFR JAN 2011: MODULE B: EMERG 2

12. Decompression Sickness 12SYMPTOMS Generally unwell / Extreme fatigue Generally unwell / Extreme fatigue Skin itching / Shortness of breath Skin itching / Shortness of breath Pain in the limbs and joints / pins & needles / loss of sensation Pain in the limbs and joints / pins & needles / loss of sensation Dizziness / visual disturbance / Dizziness / visual disturbance / Muscle weakness / loss of sensation Muscle weakness / loss of sensation Inability to control bowel or bladder functions Inability to control bowel or bladder functions Confusion / disorientation Confusion / disorientationSIGNS A blotchy, mottled, red rash on skin A blotchy, mottled, red rash on skin Loss of power leading to paralysis Loss of power leading to paralysis Staggering / loss of balance Staggering / loss of balance Choking / shortness of breath / Itching Choking / shortness of breath / Itching Collapse or unconsciousness Collapse or unconsciousness DFR JAN 2011: MODULE B: EMERG 2

13. Decompression Sickness 13TREATMENT 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

14. 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 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

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16. Pulmonary Barotrauma DFR JAN 2011: MODULE B: EMERG 2

17. Effect of Boyle’s law 17 30 metres - 4 bar absolute 10 metres - 2 bar absolute 20 metres - 3 bar absolute Surface 0 metres - 1 bar absolute DFR JAN 2011: MODULE B: EMERG 2

18. Pulmonary Barotrauma 18 BURST LUNG Excess air pressure in the lungs (usually from not exhaling properly on ascent) Excess air pressure in the lungs (usually from not exhaling properly on ascent) over-expands the lung over-expands the lung the lung ruptures the lung ruptures SEVERAL CONDITIONS MIGHT ARISE........ Air embolism (Arterial gas embolism) Air embolism (Arterial gas embolism) Pneumothorax Pneumothorax Mediastinal emphysema Mediastinal emphysema Subcutaneous emphysema Subcutaneous emphysema DFR JAN 2011: MODULE B: EMERG 2

19. 19 PneumothoraxPneumothorax Air escaping into the Pleural cavity causes the lung to collapse Arterial Gas Embolism Bubbles of Air entering the Blood Vessels Bubbles in Carotid Artery leading to Brain Ruptured Alveoli and Blood Vessels Mediastinal Emphysema Air escaping into the Mediastinum causes compression of the heart and lungs Subcutaneous Emphysema Air from Mediastinum collects under skin of neck compressing the Trachea DFR JAN 2011: MODULE B: EMERG 2

20. Pulmonary Barotrauma 20 SYMPTOMS Onset usually on surfacing Onset usually on surfacing Chest pain / shortness of breath Chest pain / shortness of breath Dizziness / visual blurring Dizziness / visual blurring Weakness WeaknessSIGNS Breathing - Difficult - rapid – shallow – absent Breathing - Difficult - rapid – shallow – absent Swelling of the neck / Crackling sound / feeling around the neck Swelling of the neck / Crackling sound / feeling around the neck Paralysis or weakness of the limbs Paralysis or weakness of the limbs Cough / Cyanosis; blue lips, fingertips Cough / Cyanosis; blue lips, fingertips Change in voice Change in voice Convulsions..... Unconsciousness Convulsions..... Unconsciousness DFR JAN 2011: MODULE B: EMERG 2

21. Pulmonary Barotrauma 21Treatment Immediate Recompression Immediate Recompression Monitor A, B, C / 100% oxygen / Alert EMS Monitor A, B, C / 100% oxygen / Alert EMS No food or fluids No food or fluids If injuries permit; comfortable position If injuries permit; comfortable position Keep victim at a comfortable temperature Keep victim at a comfortable temperature Check for bleeding and other injuries Check for bleeding and other injuries Recognise and treat for shock Recognise and treat for shockTreatment Immediate Recompression Immediate Recompression Monitor A, B, C / 100% oxygen / Alert EMS Monitor A, B, C / 100% oxygen / Alert EMS No food or fluids No food or fluids If injuries permit; comfortable position If injuries permit; comfortable position Keep victim at a comfortable temperature Keep victim at a comfortable temperature Check for bleeding and other injuries Check for bleeding and other injuries Recognise and treat for shock Recognise and treat for shock DFR JAN 2011: MODULE B: EMERG 2

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23. Reading CFT Trainee + Club Diver Course MaterialsCFT Trainee + Club Diver Course Materials DDRC Underwater Diving Accident ManualDDRC Underwater Diving Accident Manual –Ignore pages 13-15 –CFT DFR course does not currently teach ‘Five Minute Neuro Exam’‘Five Minute Neuro Exam’ 23 DFR JAN 2011: MODULE B: EMERG 2

24. Module B: Diving Emergencies 1 Barotrauma Has covered:Has covered: –Overview - Physics and physiology –Emergency care of Decompression Illness (DCI) Decompression SicknessDecompression Sickness Pulmonary Barotrauma (Burst Lung)Pulmonary Barotrauma (Burst Lung) Closing StatementClosing Statement Effective first response followed by prompt treatment by the emergency services, usually with recompression, is necessary to treat barotrauma incidents 24 DFR JAN 2011: MODULE B: EMERG 2

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