True or false: Unconscious patients should always be given IV fluids.
True
IV drip rate
75-100 cc/min
Types of IV
Normal saline/ lactated ringers
Avoid fluids containing glucose
Three IT breathing requirements
1: All chamber occupants may breathe 100% O2 at 45fsw or shallower
2: Tenders should not strap O2 to their face
3: Deeper than 45 fsw, at least one chamber occupant must breathe air.
Gas mixture at 0-60 fsw
100% O2
Gas mixture between 61-165 fsw
50/50 (O2/AIR)
Gas mixture between 166-225
64/36 (HeO2 only)
Normal Blood pressure
90/60-120/80 (Systolic/ Diastolic) (Measured in millimeters of mercury)
Normal Respiratory rate(RR)
12-18
Normal Pulse
60-80 BPM
Normal temperature
97.8-99.1
Normal SPO2 (Peripheral capillary oxygen saturation)
95-100%, (Under 90 considered very low)
12 Cranial nerves(OOOTTAFAGVSH)
1: Olfactory
2: Optic
3: Oculomotor
4: Trochlear
5: Trigeminal
6: Abducens
7: Facial
8: Acoustic
9: Glossopharyngeal
10: Vagus
11: Spinal Accessory
12: Hypoglossal
Strength scale
0- paralysis
1- profound weakness(flicker or trace muscle contraction)
2- Severe weakness, able to contract muscle but unable to move against gravity
3- Moderate weakness, able to overcome gravity, but not force of examiner
4- Mild weakness, able to resist slight force of examiner
5- normal
Using a tourniquet
- Don’t use a tourniquet unless you can’t control bleeding by any other means.
- Only use tourniquet for bleeding on limbs.
- Always apply tourniquet above the wound and not below the knee or the elbow except for complete amputations
- Do not make tourniquet any tighter than necessary to stop the bleeding
- Do not loosen a tourniquet once it has been applied, transport to medical facility.
- Do not cover tourniquet with dressing, make tourniquet obviously identifiable.
Urinary output
0.5 cc(ml) per kilogram (of patient) per hour
What should you do if your patient develops CNS O2 Toxicity during the following treatment tables? TT5, TT6, TT6A?
- Remove mask
- After all symptoms have completely subsided, decompress 10 feet at a rate of 1 fsw/min. For a convulsion, begin travel when the patient is fully relaxed and breathing normally.
- Resume O2 breathing at the shallower depth at the point of interruption.
- If another oxygen symptom occurs after ascending 10 fsw, contact an Undersea Medical Officer to recommend appropriate modifications to the treatment schedule.
What should you do if your patient develops CNS O2 Toxicity during the following treatment tables? TT4, TT7, TT8?
- Remove the mask
- Consult with a UMO before administering further oxygen breathing. No compensatory lengthening of the table is required for interruption in oxygen breathing.
Loss of O2 during a treatment (if we get O2 back within 15 min)
- Maintain depth until we get O2 back
- After O2 is restored, resume treatment at point of interruption
Loss of O2 during a treatment (if repair takes between 15 min to 2 hours)
- maintain depth until we get O2 back
- After O2 is restored.
- TT5, TT6, TT6A
- Complete the treatment table with the maximum number of O2 extensions.
- TT4, TT7, TT8
- when O2 is restored continue treatment from where it was stopped.
What do you do if O2 breathing can not be restored in 2 hours?
Switch to comparable air treatment table at current depth for decompression if 60fsw or shallower. If symptoms get worse and we need to go deeper. use treatment table 4.
CNS O2 Hits
A CNS O2 hit is when a patient experiences a symptom of CNS 02 toxicity while breathing o2 at depth.
-Further explanation
If a patient experiences a non-convulsive CNS o2 hit, simply remove the mask and and wait 15 minutes to resume o2 breathing at the point of interruption
For a second sign or if the first symptom is a convulsion
-Remove the mask and decompress 10fsw at a rate of 1fsw/min. For a convulsion wait until the patient is relaxed and breathing normally.
Resume o2 at the shallower depth at the point of interruption.
If another o2 symptom occurs after ascending 10fsw. Notify UMO to recommend appropriate modifications to the treatment schedule.
Flying after treatment
- Patients with residual symptoms should fly only with the concurrence of UMO
- Patients treated for DCS or AGE should not fly for 72 hours
- Tenders on treatment tables 5, 6, 6a, 1a, 2a, and 3 should have a 24 hour surface interval
- Treatment tables 4, 7, and 8 should wait 72 hours before flying
Eating and sleeping
The only time that a patient should be kept awake during a treatment is when when they are breathing oxygen deeper than 30fsw
Food may be consumed by patient at any time. Fluid intake must be maintained.
