a oxygen administration

8/3/2019 A Oxygen Administration

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6A Oxygen Administration6A Oxygen Administration

DAN Oxygen CourseDAN Oxygen Course


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Nature of Diving InjuriesNature of Diving Injuries

Recognition of diving injury is based on:Recognition of diving injury is based on:

Recent history of scuba divingRecent history of scuba diving Presence of signs and symptomsPresence of signs and symptoms

There is no definitive test or unique set ofThere is no definitive test or unique set of

signs or symptoms to confirm the existencesigns or symptoms to confirm the existenceof DCI for the rescuerof DCI for the rescuer

Broad range of signs and symptoms that areBroad range of signs and symptoms that aresimilar to other illnesses and injuries.similar to other illnesses and injuries.


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Signs and SymptomsSigns and Symptoms

SignsSignsmedical conditions that can bemedical conditions that can be

observedobserved Ex: Bleeding, staggering, unconsciousnessEx: Bleeding, staggering, unconsciousness

SymptomsSymptomsnonnon--observable conditionsobservable conditionsdescribed by the ill or injured persondescribed by the ill or injured person

Ex: feeling of weakness, numbness or tinglingEx: feeling of weakness, numbness or tingling


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Nature of Diving InjuriesNature of Diving Injuries

Most serious diving injuries:Most serious diving injuries:

NearNear--drowningdrowning Decompression SicknessDecompression Sickness

Arterial Gas EmbolismArterial Gas Embolism


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Near DrowningNear Drowning

Results from suffocation due to submersionResults from suffocation due to submersion

in waterin water

Impairs the ability of the lungs to performImpairs the ability of the lungs to performgas exchangegas exchange

May include aspiration of fluids into theMay include aspiration of fluids into thelungslungs

Results in hypoxia and possibly respiratoryResults in hypoxia and possibly respiratory

and cardiac arrestand cardiac arrest Contributing factors include diver panic andContributing factors include diver panic and

overweighting.overweighting.


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Decompression SicknessDecompression Sickness

Nitrogen is absorbed by the tissues duringNitrogen is absorbed by the tissues during

the divethe dive DCS is the result of nitrogen bubbleDCS is the result of nitrogen bubble

formation and growth during and after ascentformation and growth during and after ascent

Effects can include distortion or tearing ofEffects can include distortion or tearing oftissue, reduction or stoppage of blood flow,tissue, reduction or stoppage of blood flow,

and activation of blood clotting mechanismsand activation of blood clotting mechanisms

Contributing factors for bubble formationContributing factors for bubble formation

Excess nitrogen, rapid ascent, flying after divingExcess nitrogen, rapid ascent, flying after diving


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Arterial Gas EmbolismArterial Gas Embolism

AGE is most serious result of a lungAGE is most serious result of a lung

overexpansion injuryoverexpansion injury

Gas enters bloodstream, travels to heart andGas enters bloodstream, travels to heart andarterial systemarterial system

May block major arteriesMay block major arteries Cuts off supply of oxygenated bloodCuts off supply of oxygenated blood

Contributing factors includeContributing factors include Rapid ascent, breath holding on ascent, lungRapid ascent, breath holding on ascent, lung

damage, lung congestion, asthma or other airdamage, lung congestion, asthma or other air--trapping mechanismstrapping mechanisms


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DCS and AGEDCS and AGE

DCSDCS

Delayed symptom onsetDelayed symptom onset(up to 48 hours)(up to 48 hours)

Any area of the bodyAny area of the body

may be affected andmay be affected and

signs and symptomssigns and symptoms

are often dependant onare often dependant on

the area of the bodythe area of the body

affectedaffected

AGEAGE

Rapid and dramaticRapid and dramaticsymptom onsetsymptom onset

Commonly affects theCommonly affects the

brain. Signs andbrain. Signs and

symptoms similar tosymptoms similar to

strokestroke

May accompany otherMay accompany other

pulmonary barotraumapulmonary barotrauma


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DCS and AGE signs and symptomsDCS and AGE signs and symptoms

DCSDCS

Numbness, joint/limbNumbness, joint/limb

pain or tinglingpain or tinglingsensation, headache,sensation, headache,weakness, paralysis,weakness, paralysis,dizziness, unusualdizziness, unusual

fatigue, nausea,fatigue, nausea,difficulty walking,difficulty walking,muscle twitching,muscle twitching,unequal pupil size, skinunequal pupil size, skin

rash and itching,rash and itching,slurred speech,slurred speech,deafness, ringing indeafness, ringing inearsears

AGEAGE

Unconsciousness,Unconsciousness,

paralysis, convulsions,paralysis, convulsions,difficulty breathing,difficulty breathing,respiratory arrest,respiratory arrest,dizziness, visualdizziness, visual

disturbance, chest pain,disturbance, chest pain,disorientation, deathdisorientation, death


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Sign and Symptom RecognitionSign and Symptom Recognition

Recognition of signs and symptoms is theRecognition of signs and symptoms is the

first step in managing a diving injuryfirst step in managing a diving injury Injured diver less likely to have residualInjured diver less likely to have residual

symptoms when definitive treatment at asymptoms when definitive treatment at a

recompression facility is proved soon afterrecompression facility is proved soon afterthe onset of sings and symptomsthe onset of sings and symptoms

55--minute Fieldminute FieldNeuroNeuro

If a diving injury is suspected, administerIf a diving injury is suspected, administer

100% oxygen immediately.100% oxygen immediately.


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55--minute Fieldminute FieldNeuroNeuro

1.1. Orientation: name, place and timeOrientation: name, place and time

2.2. Eyes: movement, peripheral vision, and pupil sizeEyes: movement, peripheral vision, and pupil size3.3. Face: sensation, furrow brow, smile and whistleFace: sensation, furrow brow, smile and whistle

4.4. Ears: hearing, abnormal sounds?Ears: hearing, abnormal sounds?

5.5. Swallow: watch AdamSwallow: watch Adams Apple move up and downs Apple move up and down6.6. Shoulders: shrug resistanceShoulders: shrug resistance

7.7. Arms and hands: sensation, grip strength,Arms and hands: sensation, grip strength,

resistanceresistance8.8. Legs: DUI check, leg strength and resistanceLegs: DUI check, leg strength and resistance

9.9. Repeat hourlyRepeat hourly


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OxygenOxygen

Oxygen gradesOxygen grades

Use only medical or higher gradeUse only medical or higher gradeoxygen for treatment of diving injuriesoxygen for treatment of diving injuries

Oxygen cylinder fillingOxygen cylinder filling

PrescriptionPrescription Documentation of training (DAN card)Documentation of training (DAN card)

Oxygen cylindersOxygen cylinders

GreenGreen

Hydrostatic testingHydrostatic testing


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OxygenOxygen

Oxygen poisoning or toxicity can occur byOxygen poisoning or toxicity can occur by

breathing high concentrations of oxygen forbreathing high concentrations of oxygen foran extended period of time.an extended period of time.

Oxygen toxicity is not a concern for theOxygen toxicity is not a concern for the

Oxygen Provider rendering first aid.Oxygen Provider rendering first aid.


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Oxygen SafetyOxygen Safety

Extinguish all flames and smoking materialsExtinguish all flames and smoking materials

Do not use oxygen in the presence of oils,Do not use oxygen in the presence of oils,grease or flammable substancesgrease or flammable substances

Always use oxygen in wellAlways use oxygen in well--ventilated areasventilated areas

Only use equipment designated for use withOnly use equipment designated for use with

oxygenoxygen

Maintain and service oxygen equipmentMaintain and service oxygen equipment Always secure oxygen cylinders duringAlways secure oxygen cylinders during

transportationtransportation


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Benefits of OxygenBenefits of Oxygen

Increase pressure gradient to facilitateIncrease pressure gradient to facilitate

elimination of nitrogenelimination of nitrogen Reduces bubble sizeReduces bubble size

Oxygenate hypoxic tissuesOxygenate hypoxic tissues

Reduces tissue edemaReduces tissue edema

Relieves symptomsRelieves symptoms

Ease breathingEase breathing May reduce the risk of residual symptomsMay reduce the risk of residual symptoms

after hyperbaric treatmentafter hyperbaric treatment


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Oxygen EquipmentOxygen Equipment

Demand system is preferable over aDemand system is preferable over aconstantconstant--flow system for a conscious diverflow system for a conscious diverneeding oxygenneeding oxygen

Cylinder capacity should allow for oxygen toCylinder capacity should allow for oxygen to

be provided from the dive site to nearestbe provided from the dive site to nearestmedical facilitymedical facility

Be properly trained for oxygen deliveryBe properly trained for oxygen delivery

device to be useddevice to be used Check oxygen equipment and cylinderCheck oxygen equipment and cylinder

pressure before divingpressure before diving


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Oxygen EquipmentOxygen Equipment

CylinderCylinder

RegulatorRegulatorMultifunctionMultifunction DemandDemand

Constant flow with adjustable flowConstant flow with adjustable flowraterate

Oxygen tubing or hosesOxygen tubing or hoses

Oxygen maskOxygen mask3 varieties3 varieties

Demand inhalatorDemand inhalator NonNon--rebreatherrebreather

PocketPocket


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Oxygen Delivery UnitsOxygen Delivery Units

Provide 100% oxygenProvide 100% oxygen

Use for breathing and nonUse for breathing and non--breathing injuredbreathing injureddiversdivers

Can provide oxygen to multiple injuredCan provide oxygen to multiple injured

divers at the same timedivers at the same time

Waterproof case that can accommodateWaterproof case that can accommodate

multiple cylinder sizesmultiple cylinder sizes


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MasksMasks

Demand InhalatorDemand Inhalator

Preferred mask for breathing diversPreferred mask for breathing divers Delivers highest concentration of oxygenDelivers highest concentration of oxygen

Diver can hold against face, assuring sealDiver can hold against face, assuring seal

Can drink fluids while receiving oxygenCan drink fluids while receiving oxygen

Longer tankLonger tank--life because itlife because its a demands a demand

system, not constant flowsystem, not constant flow


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MasksMasks

NonNon--rebreatherrebreather

Can be used for a:Can be used for a: Conscious diver who cannot tolerate the demand inhalatorConscious diver who cannot tolerate the demand inhalator

maskmask

Unconscious, breathing diverUnconscious, breathing diver

Constant flow systemConstant flow system

Set flow rate to 15 liters per minuteSet flow rate to 15 liters per minute

Prime bagPrime bag

Place mask on injured diver, tighten with attachedPlace mask on injured diver, tighten with attached

straps and nose bridgestraps and nose bridge

Does not seal as well as demand inhalator maskDoes not seal as well as demand inhalator mask


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MasksMasks

Pocket MaskPocket Mask OroOro--nasal masknasal mask

Can be used for a:Can be used for a:

NonNon--breathing diver to provide CPR withbreathing diver to provide CPR withsupplemental oxygen (use as constant flow withsupplemental oxygen (use as constant flow with

flow rate set at 15flow rate set at 15lpmlpm)) Conscious diver, just like a demand inhalatorConscious diver, just like a demand inhalator

maskmask

Mouthpiece and one way valveMouthpiece and one way valve AirAir--filled sides to provide good fitfilled sides to provide good fit

Lift chin into the mask and press down firmly acrossLift chin into the mask and press down firmly across

nose and cheeks.nose and cheeks.


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ReminderReminder

Check oxygen unit before each diveCheck oxygen unit before each dive

PSIPSI ComponentsComponents

Have enough oxygen to transport diver fromHave enough oxygen to transport diver from

the dive site to the nearest medical facilitythe dive site to the nearest medical facility Always use oxygen in a well ventilated areaAlways use oxygen in a well ventilated area

Practice oxygen first aid skills annually (DivePractice oxygen first aid skills annually (DiveProgram requirement)Program requirement)

Promptly transport injured diver to nearestPromptly transport injured diver to nearest

medical facilitymedical facility

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