EMS World

AUG 2011

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DIVING EMERGENCIES began complaining of pain in his chest and difficulty breathing. The crew placed him on oxygen and, within minutes, he began coughing up blood. The rapid ascent and quick onset of signs and symptoms indicates this may be a case of pulmonary barotrauma. His confused behavior during the dive indicates he may have been experiencing nitrogen narcosis, which ultimately leads to a rapid and dangerous ascent. He should be provided oxygen and transported immediately. Conclusion This article is a general overview designed to remove some of the mystery surrounding diving emergencies. There is a wealth of material available for review that goes into further details of the “hows and whys” of diving medicine and emergen- cies, ranging from the theories of bubble formation to whether certain conditions like EMERGENCY MARKETPLACE Online Paramedic Program The National Medical Education & Training Center sponsored by The University of Texas Health Science Center announces an innovative state-of-the-art Online Paramedic Program It’s time to break down the brick- and-mortar barriers of the traditional classroom and build the foundation for your future. Enroll in an unparalleled paramedic program using the best of today’s technology NMETC’s Live Interactive Online Program is a web- based virtual classroom that couples the convenience of web-based training with the value of the face-to- face classroom. Experience total-application-sharing at its fi nest. Instructors show and narrate PowerPoint slides, enhance your learning with audio and video clips as examples, provide handouts to guide self-study – any traditional classroom convenience is available to maximize the learner’s experience. Interact with expert instructors and students at various levels in the learn- ing process. Ask questions, make comments, and be a part of a community with a common goal. www.nmetc.com NEED A JOB? VISIT Need to Fill an EMS Position? CONTACT JAN VARNES 1-800-547-7377 x4423 Jan.Varnes@ cygnus.com Circle 37 on Reader Service Card 64 AUGUST 2011 | EMSWORLD.com Circle 38 on Reader Service Card diabetes or spontaneous pneumothorax are contraindications to diving.13 REFERENCES 1. Note that the effects of the gas laws are not totally distinct, and one or more may contribute to various illness and injury. 2. Chapter 2, p. 37. Diving Physiology In Plain English. Ed. Jolie Bookspan. Undersea and Hyperbaric Medical Society, 5th printing (2003). Also see Diving and Subaquatic Medicine, 4th Edition, p. 295, 2005. 3. Conditions for hypothermia, hyperthermia and dehydration can exist at the same time. For instance, divers can “gear up” with heavy equipment in the heat of summer and be subjected to extreme cold when they enter the water. 4. Diving Physiology, Chapter 2, p. 43, 2003. 5. Divers use a variety of techniques to ensure that the air pressure in spaces, particularly the ears, is the same as external pressure. These techniques include yawning, swallowing or pinching the nostrils and blowing air through the Eustachian tubes using a Valsalva maneuver. Equipment like masks also have air spaces that divers equalize. Any place where air can be trapped, including improperly fi lled cavities in teeth, are subject to barotrauma. 6. Vertigo can escalate into other problems as the diver becomes confused, disoriented and/or panics. 7. Diver’s Alert Network, Annual Diving Report, p. 34, 2008. The presence of neurological symptoms and an onset time of 15 minutes or less is generally used by DAN to determine a “probable” case of AGE. 8. Different tissues absorb gas at different rates. Some tissue may be saturated, while other tissue is still absorbing nitrogen. Bubble formation is an extensive subject area, and the example is general. 9. Divers use various tables and computers in order to reduce risks associated with bubble formation. Recreational divers generally do no-decompression dives so they can descend and ascend without having to stop and allow additional time for nitrogen to be removed. As a matter of caution, no-decompression dives may include a “safety stop” at 15 feet for 3–5 minutes. A decompression dive requires one or more stops while ascending. 10. Drowning is always a concern when responding to a diving emergency and is the most common cause of scuba-related death. Over 50% of recreational scuba- related deaths among recreational divers were due to drowning. Divers Alert Network, Annual Diving Report, p. 59, 2007 edition, Durham, NC. It should be noted that drowning is often listed when other causes of death could be involved, since drowning will ultimately occur. 11. Nitrox refers to a gas that contains oxygen and nitrogen where the percentage of O2 as found in normal air. 12. Diving Physiology, p. 511, 2003. 13. Divers with diabetes can dive, and there are recommended guidelines on monitoring blood sugar before and after the dive. A history of spontaneous pneumothorax is a generally considered to be a contraindication to diving. is higher than 21%

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