6A Oxygen Administration

DAN Oxygen Course

Nature of Diving Injuries

Recognition of diving injury is based on:
Recent history of scuba diving Presence of signs and symptoms

There is no definitive test or unique set of signs or symptoms to confirm the existence of DCI for the rescuer Broad range of signs and symptoms that are similar to other illnesses and injuries.

Signs and Symptoms

Signs medical conditions that can be observed
Ex: Bleeding, staggering, unconsciousness

Symptoms non-observable conditions described by the ill or injured person

Ex: feeling of weakness, numbness or tingling

Nature of Diving Injuries

Most serious diving injuries: Near-drowning Decompression Sickness Arterial Gas Embolism

Near Drowning
Results from suffocation due to submersion in water Impairs the ability of the lungs to perform gas exchange May include aspiration of fluids into the lungs Results in hypoxia and possibly respiratory and cardiac arrest Contributing factors include diver panic and overweighting.

Decompression Sickness
Nitrogen is absorbed by the tissues during the dive DCS is the result of nitrogen bubble formation and growth during and after ascent Effects can include distortion or tearing of tissue, reduction or stoppage of blood flow, and activation of blood clotting mechanisms Contributing factors for bubble formation
Excess nitrogen, rapid ascent, flying after diving

Arterial Gas Embolism

AGE is most serious result of a lung overexpansion injury Gas enters bloodstream, travels to heart and arterial system May block major arteries Cuts off supply of oxygenated blood Contributing factors include
Rapid ascent, breath holding on ascent, lung damage, lung congestion, asthma or other airtrapping mechanisms

DCS and AGE

DCS Delayed symptom onset (up to 48 hours) Any area of the body may be affected and signs and symptoms are often dependant on the area of the body affected AGE Rapid and dramatic symptom onset Commonly affects the brain. Signs and symptoms similar to stroke May accompany other pulmonary barotrauma

DCS and AGE signs and symptoms

DCS Numbness, joint/limb pain or tingling sensation, headache, weakness, paralysis, dizziness, unusual fatigue, nausea, difficulty walking, muscle twitching, unequal pupil size, skin rash and itching, slurred speech, deafness, ringing in ears AGE Unconsciousness, paralysis, convulsions, difficulty breathing, respiratory arrest, dizziness, visual disturbance, chest pain, disorientation, death

Sign and Symptom Recognition

Recognition of signs and symptoms is the first step in managing a diving injury Injured diver less likely to have residual symptoms when definitive treatment at a recompression facility is proved soon after the onset of sings and symptoms 5-minute Field Neuro If a diving injury is suspected, administer 100% oxygen immediately.

5-minute Field Neuro

1. 2. 3. 4. 5. 6. 7. Orientation: name, place and time Eyes: movement, peripheral vision, and pupil size Face: sensation, furrow brow, smile and whistle Ears: hearing, abnormal sounds? Swallow: watch Adams Apple move up and down Shoulders: shrug resistance Arms and hands: sensation, grip strength, resistance 8. Legs: DUI check, leg strength and resistance 9. Repeat hourly

Oxygen
Oxygen grades
Use only medical or higher grade oxygen for treatment of diving injuries

Oxygen cylinder filling

Prescription Documentation of training (DAN card)

Oxygen cylinders Green Hydrostatic testing

Oxygen
Oxygen poisoning or toxicity can occur by breathing high concentrations of oxygen for an extended period of time. Oxygen toxicity is not a concern for the Oxygen Provider rendering first aid.

Oxygen Safety
Extinguish all flames and smoking materials Do not use oxygen in the presence of oils, grease or flammable substances Always use oxygen in well-ventilated areas Only use equipment designated for use with oxygen Maintain and service oxygen equipment Always secure oxygen cylinders during transportation

Benefits of Oxygen
Increase pressure gradient to facilitate elimination of nitrogen Reduces bubble size Oxygenate hypoxic tissues Reduces tissue edema Relieves symptoms Ease breathing May reduce the risk of residual symptoms after hyperbaric treatment

Oxygen Equipment
Demand system is preferable over a constant-flow system for a conscious diver needing oxygen Cylinder capacity should allow for oxygen to be provided from the dive site to nearest medical facility Be properly trained for oxygen delivery device to be used Check oxygen equipment and cylinder pressure before diving

Oxygen Equipment
Cylinder Regulator Multifunction
Demand Constant flow with adjustable flow rate

Oxygen tubing or hoses Oxygen mask 3 varieties

Demand inhalator Non-rebreather Pocket

Oxygen Delivery Units

Provide 100% oxygen Use for breathing and non-breathing injured divers Can provide oxygen to multiple injured divers at the same time Waterproof case that can accommodate multiple cylinder sizes

Masks
Demand Inhalator Preferred mask for breathing divers Delivers highest concentration of oxygen Diver can hold against face, assuring seal Can drink fluids while receiving oxygen Longer tank-life because its a demand system, not constant flow

Masks
Non-rebreather
Can be used for a:
Conscious diver who cannot tolerate the demand inhalator mask Unconscious, breathing diver

Constant flow system Set flow rate to 15 liters per minute Prime bag Place mask on injured diver, tighten with attached straps and nose bridge Does not seal as well as demand inhalator mask

Masks
Pocket Mask
Oro-nasal mask Can be used for a: Non-breathing diver to provide CPR with supplemental oxygen (use as constant flow with flow rate set at 15 lpm) Conscious diver, just like a demand inhalator mask Mouthpiece and one way valve Air-filled sides to provide good fit Lift chin into the mask and press down firmly across nose and cheeks.

Reminder
Check oxygen unit before each dive
PSI Components

Have enough oxygen to transport diver from the dive site to the nearest medical facility Always use oxygen in a well ventilated area Practice oxygen first aid skills annually (Dive Program requirement) Promptly transport injured diver to nearest medical facility