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 air-
trapping mechanisms
 DCS and AGE
DCS AGE
• Delayed symptom onset • Rapid and dramatic
(up to 48 hours) symptom onset
• Any area of the body • Commonly affects the
may be affected and brain. Signs and
signs and symptoms symptoms similar to
are often dependant on stroke
the area of the body • May accompany other
affected pulmonary barotrauma
 DCS and AGE signs and symptoms
DCS AGE
• Numbness, joint/limb • Unconsciousness,
pain or tingling paralysis, convulsions,
sensation, headache, difficulty breathing,
weakness, paralysis, respiratory arrest,
dizziness, unusual dizziness, visual
fatigue, nausea, disturbance, chest pain,
difficulty walking, disorientation, death
muscle twitching,
unequal pupil size, skin
rash and itching,
slurred speech,
deafness, ringing in
ears
 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. Orientation: name, place and time
2. Eyes: movement, peripheral vision, and pupil size
3. Face: sensation, furrow brow, smile and whistle
4. Ears: hearing, abnormal sounds?
5. Swallow: watch Adam’s Apple move up and down
6. Shoulders: shrug resistance
7. 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 it’s 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