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IT
IT general Board Prep
| Question | Answer |
|---|---|
| How many inside tenders are required for a chamber treatment at all times? | At least 1 |
| Requirements for non DMT to become an inside tender | -NAVEDTRA 43910 Inside tender PQS -Current dive physical -conform to navy physical standards -Pass diver candidate pressure test |
| Insider tender responsibilities (8) | Releasing door after seal made Comms with outside personnel First aid Monitoring vitals Administering Treatment gas Monitoring O2 toxitiy Ensure hearing protection Ensure patient is laying flat, permit good blood flow to all extremities |
| When should patient always be assumed to be suffering from AGE? | -surfaces unconscious, loses consciousness at any time -neuro symptoms in first 10 min on surface |
| Is defibrillation authorized at depth? | No |
| Diagnosis of DCS %/hours after exposure | 42% -- 1 hr 60% -- 3 hrs 83% -- 8 hrs 98% -- 24hrs |
| Dive manual appendix for neuro exam | 5A |
| Never interrupt chest compressions for longer than ______ seconds. | 10 seconds |
| Never wait for bag resuscitator. Instead do what? | mouth to mouth with barrier device immediately if breathing ceases |
| 100% O2 shall never be used below what depth when treating AGE/DCS? | 60 fsw |
| Primary objectives of recompression treatment (3) | Compress gas bubbles to small volume Allow sufficient time for reabsorption Increase blood O2 content and O2 delivery to injured tissues |
| Guidance of recompression treatment (5) | -Treat promptly and adequately -Effectiveness of Tx decreases as time between onset and Tx increases -Do no ignore minor symptoms -Follow tables unless changes made by UMO -Multiple symptoms occur, treat for most serious condition |
| Transporting the patient to chamber | Keep patient supine, do not put head down Keep warm, comfortable 100% O2 monitor for blocked airway, cessation of breathing, cardiac arrest, shock |
| Medical treatment during transport | 100% O2 Hydrated |
| If patient moved by unpressurized aircraft, then aircraft should fly below what altitude? | 1,000 ft |
| Examples of TT9 uses | Residual symptoms of DCS/AGE Selected cases CO poisoning Smoke inhalation crushing injury gas gangrene bone/tissue necrosis |
| What authorization required to press non diving related patient? | BUMED Code M95 Done under cognizance of UMO |
| How much fluids are administered to keep a conscious patient hydrated? | 1-2 liters during course of TT5 or 6 |
| Drip rate for IVs | 75-100 cc/hr |
| Two types of IV solution | Lactated Ringers Normal saline |
| What should not be administered if brain or spinal cord injury? | Dextrose |
| When are catheters used? | Bladder paralysis/patient cannot control bladder |
| Always inflate urinary cather with_____, never______. | liquid never air |
| Adequate urinary output | 0.5 -1.0 cc/kg BW/hr (clear colorless urine) |
| Never attempt TT longer than ______ unless there is access to inside occupants | TT6 |
| All chamber occupants can breathe 100% O2 at depths of ________ | 45 fsw or shallower |
| What should tenders not do with BIBS? | Not fasten it to their heads Just hold up to face |
| Deeper than 45 fsw, at least one chamber occupant must ________ | Breathe air |
| In general, tenders require surface interval of 18 hrs between consecutive treatments on what tables? | 1A, 2A, 3 5, 6, 6A |
| Tenders require surface interval of 48 hrs between consecutive treatments on what tables? | 4, 7, 8 |
| When can tenders repeat 5, 6, 6A within 18 hour surface interval? | If all O2 breathing is at 30 fsw or shallower |
| For which tables will O2 toxicity be more likely to develop? | 4, 7, 8 repeat 6 |
| Patients with symptoms of ________ may be more susceptible to O2 toxicity | Severe type II DCS AGE |
| For a convulsion, after symptoms subside, begin travel to decompress 10 fsw when? | After patient is fully relaxed and breathing normally |
| Recurrence of O2 toxicity in chamber (TT 4, 7, 8) | Remove mask Consult with UMO |
| Pulmonary symptoms: O2 treatment should still be continued when? | Neurological defecit remains, patient responding positively to Tx Continue as long as beneficial or until pain limits breathing |
| Pulmonary symptoms: What should breathing periods be changed to | 20 min O2/10 min air |
| 1A, 2A, 3, 5, 6, 6A Tender Tx frequency, consecutive treatments | 18 hrs, consecutive 1A, 2A, 3, 5, 6, 6A 48 hours 4, 7, 8 (Can repeat 5, 6, 6A w/in 18 if all O2 breathing was at 30 fsw or shallower, all other tables surface interval must be observed) |
| 4, 7, 8 tender surface interval for dives | 48 hrs |
| After TT5, patient should remain at treatment facility for how long? | 2 hrs |
| Patients treated on TT6 (DCS type I or II symptoms) should remain at treatment facility for how long? | 6 hrs |
| Post observation periods can be shortened with who's permission? If shortened what should happen? | -UMO -They remain within 30 mins of treatment facility for the rest of the observation period, Someone who can monitor their symptoms should be with them |
| Post observation requirements for all patients after chamber treatment | -Remain within 60 mins of chamber for 24 hrs -Be accompanied during that time -No patient released without UMO permission |
| Post treatment observation for inside tenders | -1 hr at treatment facility -within 60 mins of chamber for 24 hrs |
| Flying after treatment for inside tenders | 1A, 2A, 3, 5, 6, 6A ---- 24 hrs 4, 7, 8 ---- 72 hrs |
| flow rate for 100% O2 | 12-15 L/min |
| 100% O2 on surface generally tolerated for how long? | 12 hrs |
| DCS: When can patients be given oral fluids When should they not be given fluids | -conscious, able to tolerate -unconscious, stuporous, intolerable |
| DCS: Why anticoagulants are a bad idea when treating DCS When is it permitted? | -DCS can cause hemorrhaging in tissues -Lower extremity weakness (reduces risk deep vein thrombisis and pulmonary embolism) |
| AGE Why are fluid recommendations for patients different with AGE? | CNS injury in AGE may be complicated by cerebral edema, which may be worsened by an increased fluid load, thus causing further injury to the diver |
| AGE: What is the best choice for IV hydration? Why? | colloids maintaining intra-vascular volume/minimizing extravascular leakage |
| Aspirin/NSAIDs recommended for AGE/DCS? | No May worsen hemorrhaging |
| When should patients be kept awake? | O2 breathing deeper than 30 fsw |
| When can food be eaten in chamber? | Any time |
| Primary Medkit | Diagnostics/therapeutics: stethoscope reflex hammer tongue depressor pinwheel pen light otoscope disposable exam gloves skin marker eye chart Crico kit, OPA, lidocaine, BVM, pressure dressing |
| Secondary Medkit | ancillary equipment: LMA IV kit urinary catheter IO syringes chest tube surgical kits/equipment |
| Primary medkit goes where? Secondary where? | Inside chamber Outside, near chamber |
| What should happen to sterile medical equipment exposed to pressurization? | re-sterilized after each pressure exposure |
| Unopened medkits inventoried _______ | Quarterly |
| ***First duty is_______ *** | To do no harm |
| Emergency kits can be augmented by who? | UMO |
| Type of chamber at SWRMC | RCF 6500 |
| 5A: Medical History components | -Date last dive, depth, bottom time -Number of dives in last 24 hrs -Symptoms noticed before, during, after dive -During ascent or descent? -Symptom increased/decreased since onset? -Any other symptoms since onset? -Similar symptoms before? |
| 5A: Coordination tests | Walk/ Heel toe walk Romberg finger to nose heel/shin slide rapid alternating mvmt |
| 5A: Strength tests upper | fingers, forearms biceps/triceps deltoids/lats |
| 5A: Strength tests lower | adductors/abductors hip flexion/extension knee extension/flexion ankle plantar/dorsiflexion toes |
| Types of shock | Hypovolemic Cardiogenic Anaphylactic Septic Neurogenic |
| Normal saline and lactated ringers are both what type of solutions? | Crystalloids |
| Ideal Chamber manning | 7: Diving Officer MDV UMO DMT/Inside tender Chamber Supervisor Driver Comms/Logs |
| Minimum Chamber manning | 3: Chamber Supervisor Inside Tender Driver |
| Emergency Chamber Manning | 2: Chamber sup/driver Inside tender |
| Subspecialty codes of UMO | 16U0 - basic undersea medical officer 16U1-Residency in undersea medecine, trained UMO |
| POIS tree | Pulmonary Overinflation Rupture of the alveolar lining Pulmonary Interstitial emphysema AGE/Mediastinal Emphysema/Pneumothorax Subcutaneous Emphysema |
| What causes AGE? | entry of gas bubbles into arterial circulation as a result of pulmonary overinflation syndrome |
| What is the off effect? When does it occur? | -Onset or worsening of CNS O2 tox symptoms several minutes after diver comes off gas or experiences reduction in ppO2. |
| Which type of pain is treated as type II DCS? Why? | -any pain in the abdominal, hip, or thoracic areas -Indication of spinal cord involvement |
| Never interrupt chest compressions longer than ________ | 10 seconds |
| What is radicular pain? | pain radiating from a single source at nerve root to further joints/extremities |
| What is girdle pain? | pain felt around the pelvic joints, hip, lower back, thighs |
| When does inner ear DCS occur? | most often in helium-oxygen dives and during decompression when diver switched from breathing helium-oxygen to air. |
| When can the patient sleep? | anytime except when breathing O2 below 30 fsw. |
| When can the patient eat? | anytime |
| What should IT do for patient who is sleeping? | pulse, respiration, BP monitored and recorded at intervals appropriate to patient's condition |
| How often should vitals be checked? | 15 minutes - stable patient 5 minutes - unstable patient |
| Oxygen range in chamber atmosphere | 19-25% |
| Max CO2 levels in chamber atmosphere | 1.5% SEV |
| What is in a round of environmentals? | Depth, O2, CO2, temp (primary/secondary bank/manifold if applicable) |
| Chamber temp control chart | above 104 - intolerable, no tables 95-104 - 2 hrs, TT5,9 85-94 - 6 hrs, TT5, 6, 6A, 1A, 9 below 85 - unlimited, all tables |
| How many liters of water, juice, non-carbonated drink is sufficient over course of TT5 or 6 for hydration? | 1-2L |
| Never attempt treatment longer than TT6 unless... | There is access to inside occupants |
| What is necessary for a chamber to have if doing a TT 4,7, or 8? | Double lock chamber Additional personnel have to be locked in or out |
| What is used as treatment gas for treatments deeper than 60fsw? What is needed for the gas mixture? | -High Oxygen N2O2 or HeO2 -Gas must be calculated to offer ppO2 of 1.5-3.0 ata at the treatment depth. |
| DCS following helium dives can be treated with what? | nitrogen (50/50) or helium (64/36) mixtures |
| For recompression deeper than 165 fsw, which treatment gas is preferred? Why? | helium mixtures to avoid nitrogen narcosis |
| CNS O2 toxicity is unlikely at what depth, very unlikely at what depth? | unlikely for resting individuals at chamber depth 50 fsw, very unlikely at 30 FSW or shallower. |
| When can CO2 absorbent be used beyond the expiration date? | as long at the chamber has a gas analyzer/CO2 monitor |
| immediate steps for O2 hit | off O2 report to chamber supervisor |
| How many liters does a portable oxygen E cylinder hold | 669 liters |
| U.S. oxygen cylinder sizes | E Cylinder: approx length 25" D Cylinder: approx length 17" C Cylinder: approx length 11" M9 Cylinder: approx length 15" M6 Cylinder: approx length 12" M4 Cylinder: approx length 9" |
| Flow rate for O2 cylinder during transport | 12-15L/min (dive manual says 15) |
| Lidocaine IV dose | 1 mg/kg bw then continuous 2-4 mg/min |
| Strength scale | 0-paralysis 1-profound 2-severe 3-moderate 4-mild 5-normal |
| Sensory arm testing locations | upper arm below deltoid below elbow above wrist |
| Sensory leg testing locations | thigh below hip below knee above ankle |
| Three methods to control bleeding | direct pressure indirect pressure torniquet |
| If bandage is soaked through when applying direct pressure, what do you do? | apply additional bandaging on top do not remove original bandage |
| Placement location of torniquet | above wound, close to wound as possible In general, above elbow or knee joint |
| When should a tourniquet be applied | When bleeding cant be controlled by other means, however can be kept on for hours with no permanent damage |
| What happens if tourniquet pad is not placed directly on artery? | It will decrease pressure on artery and lead to increased blood flow |
| How tight should a tourniquet be? | Tight enough to stop the bleeding, but not tighter than necessary |
| In general, when can a tourniquet be placed below the elbow or knee? | Complete amputations |
| Steps to apply tourniquet | -Place pad over artery, above wound, etc. -tighten until pulse disappears/bleeding controlled -secure windlass rod (don't loosen after its been applied) -Do not cover tourniquet with dressing -Write T, time applied on forehead (or on wrist tag) |
| Can you apply bandage over tourniquet? | No |
| How is venous bleeding usually controlled? | Direct pressure |
| Controlling internal bleeding | IV fluids transport immediately (requires higher care) |
| perilymph fistula What is it and what does it cause? | -tear or defect of membranes that separate middle ear from perilymphatic space in inner ear -Causes fluid to leak into middle ear. pressure changes between the spaces. vertigo, dizziness, etc. |
| How many pressure points on the human body? | 22 (11 on each side) |
| direct bubble effect: Autochthonous bubbles effects | -put pressure on nerve endings -stretch and tear tissue causing hemorrhage -increase pressure in tissue, causing cessation of incoming blood flow |
| direct bubble effect: venous bubbles/arterial bubbles | -can block blood flow to vital organs, causing tissue hypoxia/cell death (Spinal cord/neuro DCS) -can be carried to lungs as emboli (VGE-venous gas emboli), block blood flow causing edema and decreased gas exchange (Pulmonary DCS) -AGE -- Arterial |
| AGE and autochtonous bubble formation are primary mechanisms of _______ | Cerebral DCS |
| Direct bubble effect overall characteristics | Affects primary function/blood flow through direct blockages/pressure changes Occur within short period (minutes to hours) Treated with recompression |
| Indirect bubble effects (4) | -plasma leaks from bv's (damage to endothelial lining), blood cells remain inside, blood thickens -- decreased flow -platelets released -- clotting -injured tissues release fats --clump together in bloodstream -histamine release -- allergic reactions |
| Two types of transient vertigo and what causes them | caloric (temp difference) alternobaric (pressure difference) |
| First O2 Hit procedures, non convulsive | Off O2, wait for symptoms to subside wait additional 15 mins resume O2 at point of interruption |
| Second O2 hit procedures, non convulsive | Off O2, wait for symptoms to subside Decompress 10 fsw (1 ft/min) Resume at point of interruption Reoccurance -- off O2 decompress on air |
| O2 toxicity, convulsive procedures | Off O2 wait for symptoms to subside (relaxed and breathing normally) Decompress 10 fsw (1 ft/min) Resume O2 at point of interruption Reoccurance - Off O2 decomress on air |
| TT5 Tender O2 breathing requirements | -unmodified - last 30 min during ascent from 30 fsw to surface -Previous exposure in 18hrs - additional 20 min at 30 fsw |
| TT6 Tender O2 breathing requirements | -unmodified/1 ext - 30 min at 30 fsw and during ascent -2 ext - O2 increased to 60 min at 30 fsw -Previous exposure in 18hrs - additional 60 min at 30 fsw |
| TT6A Tender O2 breathing requirements | -unmodified/1 ext - 60 min at 30 fsw and during ascent -2 ext - O2 increased to 90 min at 30 sw -Previous exposure in 18hrs -additional 60 min at 30 fsw |
| TT9 Tender O2 breathing requirements | -last 15 min at 45 fsw and during ascent (regardless of ascent rate) |
| What is KVO? | Keep vein open IV drip that is kept flowing just enough to keep IV open for future use |
| What is Bolus? | dose of a substance given intravenously to rapidly achieve its therapeutic effect by immediately delivering its intended concentration in the blood. |
| IV insertion angle | 15-30 degrees (enough to get it in the vein properly) |
| Most commontype of barotrauma Symptoms? | middle ear squeeze sharp pain, fullness in ear, hearing loss, vertigo |
| When performing walk and heel/toe walk during coordination, what do I need to make sure of first | Patient looks straight ahead at me and not at their feet |
| Brief for pinwheel during sensory | Can you feel that? That's sharp, that's dull. Let me know if sharp changes to dull at any point. |
| When can someone who is not IT qualified/current dive physical etc. get in chamber to treat patient? | Emergency. Best person qualified to treat the patient. Non diving MD, surgeon, nurse etc. |
| Tidal volume: At rest Severe work | Rest-0.5L Severe work-3L |
| A drop of ppO2 below ______ causes the onset of hypoxic symptoms | 0.16 ata |
| CNS O2 toxicity can occur at what ppO2? | 1.3 ata wet diver 2.4 ata dry diver |
| Pulmonary O2 toxicity can occur when ppO2 reaches what? (Times/ata also) | exceeds 0.5 ata -12 hours at 1 ata -4 hrs at 2 ata |
| A water temperature of approximately _______ is required to keep an unprotected, resting diver at stable temp. The diver will quickly become chilled in water temperatures below________. | 91F 72F |
| Hyperthermia is a risk when air/water temperature exceeds what? | 90F 82F |
| Body core temp should never exceed _______. | 102 F |
| What is treatment table 5 used to treat (6)? | -asymptomatic Omitted D -Type I DCS (except Cutis marmorata) when complete neuro reveals no other abnormality -resolved symptoms from in water decompression -follow up treatments for residual symptoms -CO poisoning -Gas gangrene |
| What is treatment Table 6 used to treat (8)? | -AGE -Type II DCS -Type I relief not complete 1st ten minutes at 60 (or recompression done before neuro completed) -cutis -severe CO -Asymptomatic omitted D -symptomatic uncontrolled ascent -recurrence symptoms shallower than 60 |
| What is Treatment Table 6A used for? | Severe symptoms unchanged or worsen within 1st 20 min at 60 fsw |
| What are the two parts of the central nervous system? | Brain Spinal cord |
| Parts of the peripheral nervous system | Cranial nerves Spinal nerves Sympathetic nervous system |
| Symptomatic omitted D: Which table to use? -surfaced from 50 fsw or shallower -deeper than 50 -uncontrolled ascent deeper than 165 | -surfaced 50 fsw or shallower: compress to 60 fsw, TT6 -surfaced from deeper than 50: compress to 60 or significant relief (NTE 165), TT6A Uncontrolled ascent deeper than 165, TT8 (NTE 225 fsw) |
| Treatment for joint pain only at altitude, resolved before reaching 1 ata. | 2 hrs surface O2 Neuro 24hrs observation |
| TX for other altitude symptoms or if joint pain persistent after reaching 1 ata. | Bring to chamber facility while on 100% O2, treat on appropriate table even if symptoms resolved during transport. |
| Needle thoracentesis preferred insertion sites | mid clavicular line - 2nd intercostal space Mid axillary or anterior axillary lines - 4th or 5th intercostal space |
| Where should the needle be placed for a thoracentesis, above or below the rib? Why? | above avoid damaging the neuro-vascular bundle |
| Which tissue is most susceptible to hypoxia? | Brain tissue |
| TT4 Inside tender breathing requirements | 2 hours O2 at 30 fsw prior to ascent |
| Who breathes O2 during ascent from 45 fsw to surface on TT9 | Tender only Patient is on air |
| Inside tender O2 breathing requirements for Treatment Table 7 | Tender breathes chamber air |
| When medical/physical requirements are waived for someone to get in the chamber as a non-patient | When specialized medical care is required, the most qualified person to treat the patient should provide care. |
| What type of clothing can be worn in chamber? | 100% cotton 65% polyester/35%cotton mix |
| When is an inside tender committed to the entire treatment table? | When they reach exceptional exposure |
| What is visceral pain | Vague, aching pain in chest or abdomen |
Created by:
DivingKnowledge