Diving Manual Chapter 17

Question 1

what is the minimum manning level for recompression treatments?

Answer 1

1. chamber supervisor
2. inside tender / DMT
3. outside tender

Question 2

for an emergent diving injury what is the absolute minimum number of personnel for treatment?

Answer 2

1. chamber supervisor

2. inside tender / DMT

Question 3

AGEs are treated with initial compression to ___ fsw

Answer 3

60

Question 4

if AGE symptoms are improved within the first oxygen breathing period at 60 fsw, then treatment is continued using Treatment Table ___

Answer 4

6

Question 5

if AGE symptoms are unchanged or worsen within the first oxygen breathing period at 60 fsw, then what do you do?

Answer 5

• assess patient upon descent

- compress to depth of relief NTE 165 fsw

Question 6

what % of DCS symptoms occur within 1 hour?

Answer 6

42%

Question 7

what % of DCS symptoms occur within 3 hours?

Answer 7

60%

Question 8

what % of DCS symptoms occur within 8 hours?

Answer 8

83%

Question 9

what % of DCS symptoms occur within 24 hours?

Answer 9

98%

Question 10

42% of DCS symptoms occurs within ___ hour(s)

Answer 10

1

Question 11

60% of DCS symptoms occurs within ___ hour(s)

Answer 11

3

Question 12

83% of DCS symptoms occurs within ___ hour(s)

Answer 12

8

Question 13

98% of DCS symptoms occurs within ___ hour(s)

Answer 13

24

Question 14

how does type I DCS manifest?

Answer 14

PAIN only:

• joints
• MSK
• skin
• swelling / pain of lymph nodes

Question 15

what are the hallmark characteristics of type I DCS pain?

Answer 15

• dull
• achy
• confined to particular areas
• always present at rest
• usually unaffected by movement

Question 16

how long is a patient monitored after treatment for pain-only symptoms?

Answer 16

2 hours

Question 17

how long is a patient monitored after treatment for serious symptoms?

Answer 17

6 hours

Question 18

what is the most common manifestation of DCS?

Answer 18

itching

Question 19

do you need to recompress for itching?

Answer 19

no

Question 20

do you need to recompress for faint skin rash?

Answer 20

no

Question 21

do you need to recompress for mottling / marbling of the skin (cutis marmorata)?

Answer 21

yes

Question 22

what do you do if a full neuro exam is not completed before initial recompression?

Answer 22

treat as type II DCS

Question 23

what is done if a UMO decides that pain is related to specific orthopedic trauma or injury?

Answer 23

• use treatment table 5 (if a UMO is consulted)

- use treatment table 6 (if UMO is not consulted)

Question 24

type II DCS is divided into what categories?

Answer 24

• neurological
• inner ear
• cardiopulmonary

Question 25

how is inner ear DCS differentiated from neuro (cerebellar) DCS?

Answer 25

nystagmus is typically not present in cerebellar DCS

Question 26

how does type II DCS differ from AGE?

Answer 26

time course - AGE symptoms typically occur within 10 minutes of surfacing

Question 27

is treatment table 5 an appropriate treatment for symptomatic omitted decompression?

Answer 27

no

Question 28

what do you do for a diver with symptomatic omitted decompression who surfaced from 50 ft or shallower?

Answer 28

compress to 60 fsw and begin treatment table 6

Question 29

what do you do for a diver with symptomatic omitted decompression who surfaced from deeper than 50 ft?

Answer 29

- compress to 60 fsw or the depth where the symptoms are significantly improved (NTE 165 fsw) - begin treatment table 6

Question 30

what do you do if joint point is present but resolved before reaching 1 ata from altitude?

Answer 30

treat with 2 hours of 100% oxygen breathing at the surface followed by 24 hours of observation

Question 31

what are the basic rules to be followed for all recompression treatments?

Answer 31

1. compress gas bubbles to a small volume, thus relieving local pressure and restarting blood flow 2. allow sufficient time for bubble resorption 3. increase blood oxygenation content and thus oxygen delivery to injured tissues

Question 32

which are more effective - air treatment tables or oxygen treatment tables?

Answer 32

oxygen

Question 33

what are the options if a chamber is not available?

Answer 33

1. transport to nearest chamber 2. in-water recompression *administer 100% oxygen during transport

Question 34

what are the recommendations for patient transport to a nearby chamber?

Answer 34

- supine - head up - keep warm - 100% oxygen - constant monitoring

Question 35

if a patient is moved by helicopter or other unpressurized aircraft, the aircraft should be flown as low as safely possible, preferably less than _____ ft

Answer 35

1000 ft

Question 36

when can in-water recompression be initiated?

Answer 36

if there is no benefit with 100% oxygen at the surface after 30 minutes

Question 37

when are air treatment tables 1A, 2A, and 3 used?

Answer 37

only as a last resort when oxygen is not available

Question 38

when is treatment table 5 used?

Answer 38

- type I DCS - asymptomatic omitted decompression - treatment of resolved symptoms following in-water recompression - follow-up treatments for residual symptoms - CO poisoning - gas gangrene

Question 39

when is treatment table 6 used?

Answer 39

- AGE - type II DCS - type I DCS where relief is not complete within 10 minutes at 60 feet or where pain is severe and immediate recompression must be instituted before a neuro exam can be performed - cutis marmorata - severe CO poisoning - cyanide poisoning - smoke inhalation - asymptomatic omitted decompression - symptomatic controlled ascent - recurrent of symptoms shallower than 60 fsw

Question 40

what is the VENTID-C mnemonic for oxygen toxicity symptoms?

Answer 40

``` V - vision E - ears N - nausea T - twitching / tingling I - irritability D - dizziness C - convulsions ```

Question 41

CNS oxygen toxicity is unlikely in resting individuals at chamber depths of ___ feet or shallower and very unlikely in resting individuals at chamber depths of ___ feet or shallower, regardless of the level of activity

Answer 41

- 50 | - 30

Question 42

what are the options for treatment of residual symptoms for persistent type II DCS?

Answer 42

- daily TT 6 | - BID TT 5 or 9