Decompression Sickness or Dysbarism: Difference between revisions

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==Section 6 - TRAUMA==
==Section 6 - TRAUMA==
===6.05 DECOMPRESSION SICKNESS / DYSBARISM===
===6.05 DECOMPRESSION SICKNESS / DYSBARISM===


'''ASSESS FOR SIGNS AND SYMPTOMS:'''
'''ASSESS FOR SIGNS AND SYMPTOMS:'''
* Onset usually within 1 - 3 hours after scuba diving.
* There are two primary types of decompression sickness:
* Severe, throbbing pain involving the muscles, joints and abdomen.
** Fast onset (Arterial Gas Embolism [AGE]) develops within 10 minutes of the dive
* Pruritus and mottling of the skin.
** Delayed onset usually within 1 - 12 hours after diving
* Patients with a severe reaction will have CNS and / or respiratory difficulties.
* Signs and Symptoms:
** Rapid change in mental status or unconscious upon surfacing
** Rapid changes in breathing pattern or apnea
** Extreme fatigue
** Difficulty in thinking
** Vertigo
** Progressive muscle paralysis
** Bloody sputum
** Tinnitus or severe ringing in the ears
** Severe, throbbing pain involving the muscles, joints and abdomen
** Nausea and/or vomiting
** Pruritus and mottling of the skin




[[Initial Medical Assessment and Care|INITIAL TRAUMA CARE]], (2.02) [[Medical Gases|OXYGEN]] @100% via NRB mask or assist with BVM.
'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE, (2.02)]] OXYGEN @ 100% via NRB mask or assist with BVM.'''
* Obtain IV access and INFUSE NORMAL SALINE, 1000 ml over 30 minutes.
** Stop infusion if signs of system overload appear
* If nausea or vomiting is present, ADMINISTER [[Antiemetics|Ondansteron (Zofran)]] 4 mg IVP.
** [[Antiemetics|Phenergan]] may be used as a second agent to treat nausea or if intractable vomiting is present.
* Consider facility with hyperbaric services as primary destination.
* Contact receiving facility early to allow them time to gather and prepare Hyperbaric Team.
* Contact receiving facility early to allow them time to gather and prepare Hyperbaric Team.
* Transport patient in left lateral head down position. Keep patient warm.
* Transport patient in left lateral position.
* Consider facility with hyperbaric services as primary destination.
** '''Avoid head down position''' – it causes an increased ICP, elevates intrathoracic pressure and complicates patient movement.
'''''If the patient is presenting with an altered mental status the Paramedic should notify the appropriate facility from the scene to make arrangements for the hyperbaric chamber.'''''
* Inquire from patient or bystanders the following dive profile information:
* If other significant injuries exist, follow [[Trauma Transport Protocol]] or appropriate Practice Parameters.
** Type of dive (rescue, commercial, recreational)
** Type of gases used (compressed air, nitrox, heliox)
** Water Type (Fresh, salt or contaminated)
** Number of dives and the approximate depths if possible.
** Total dive time for each dive completed today (this is extremely important for hyperbaric treatment).
 
{| class="wikitable"
|-
! If the patient is presenting with an altered mental status the Paramedic should notify the appropriate facility from the scene to make arrangements for the hyperbaric chamber and inquire if the patient is to go directly to the hyperbaric chamber for immediate treatment.
|}


'''HYPERBARIC CHAMBERS:'''
{| class="wikitable"
|-
! BLACK BOX WARNING:
Traditionally SCEMS Practice Parameters emphasize pain management. In the case of decompression sickness/dysbarism pain management utilizing narcotic pain medications MUST BE AVOIDED.
|}


''Florida Hospital South, Orlando''
{| class="wikitable"
|-
! AIR TRANSPORT
The use of air transport shall be carefully evaluated – if air transport must be utilized the pilot must be notified as typical EMS rotorcraft are not pressurized. The flight plan must be adjusted to the lowest allowable altitude to prevent further complications for the patient.
|}


''Shands Hospital, Gainesville''
'''If other significant injuries exist, follow Trauma Transport Protocol or appropriate Practice Parameters.'''


''Holmes Regional Medical Center, Melbourne''
'''HYPERBARIC CHAMBERS:'''
*Florida Hospital South, Orlando
*UF Health System (Shands) Hospital, Gainesville
*Holmes Regional Medical Center, Melbourne


[[Category:Trauma]]
[[Category:Trauma]]

Revision as of 12:50, 1 August 2013

Section 6 - TRAUMA

6.05 DECOMPRESSION SICKNESS / DYSBARISM

ASSESS FOR SIGNS AND SYMPTOMS:

  • There are two primary types of decompression sickness:
    • Fast onset (Arterial Gas Embolism [AGE]) develops within 10 minutes of the dive
    • Delayed onset usually within 1 - 12 hours after diving
  • Signs and Symptoms:
    • Rapid change in mental status or unconscious upon surfacing
    • Rapid changes in breathing pattern or apnea
    • Extreme fatigue
    • Difficulty in thinking
    • Vertigo
    • Progressive muscle paralysis
    • Bloody sputum
    • Tinnitus or severe ringing in the ears
    • Severe, throbbing pain involving the muscles, joints and abdomen
    • Nausea and/or vomiting
    • Pruritus and mottling of the skin


INITIAL TRAUMA CARE, (2.02) OXYGEN @ 100% via NRB mask or assist with BVM.

  • Obtain IV access and INFUSE NORMAL SALINE, 1000 ml over 30 minutes.
    • Stop infusion if signs of system overload appear
  • If nausea or vomiting is present, ADMINISTER Ondansteron (Zofran) 4 mg IVP.
    • Phenergan may be used as a second agent to treat nausea or if intractable vomiting is present.
  • Consider facility with hyperbaric services as primary destination.
  • Contact receiving facility early to allow them time to gather and prepare Hyperbaric Team.
  • Transport patient in left lateral position.
    • Avoid head down position – it causes an increased ICP, elevates intrathoracic pressure and complicates patient movement.
  • Inquire from patient or bystanders the following dive profile information:
    • Type of dive (rescue, commercial, recreational)
    • Type of gases used (compressed air, nitrox, heliox)
    • Water Type (Fresh, salt or contaminated)
    • Number of dives and the approximate depths if possible.
    • Total dive time for each dive completed today (this is extremely important for hyperbaric treatment).
If the patient is presenting with an altered mental status the Paramedic should notify the appropriate facility from the scene to make arrangements for the hyperbaric chamber and inquire if the patient is to go directly to the hyperbaric chamber for immediate treatment.
BLACK BOX WARNING:

Traditionally SCEMS Practice Parameters emphasize pain management. In the case of decompression sickness/dysbarism pain management utilizing narcotic pain medications MUST BE AVOIDED.

AIR TRANSPORT

The use of air transport shall be carefully evaluated – if air transport must be utilized the pilot must be notified as typical EMS rotorcraft are not pressurized. The flight plan must be adjusted to the lowest allowable altitude to prevent further complications for the patient.

If other significant injuries exist, follow Trauma Transport Protocol or appropriate Practice Parameters.

HYPERBARIC CHAMBERS:

  • Florida Hospital South, Orlando
  • UF Health System (Shands) Hospital, Gainesville
  • Holmes Regional Medical Center, Melbourne
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