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Questions and Answers
What is a common sign of decompression sickness?
What should be done if a patient with signs of decompression sickness cannot be transported to St. Mary's or Mercy's Hyperbaric Chamber?
What is the recommended oxygen flow rate for a patient suspected of decompression sickness?
What is the first treatment option indicated for a non-fatal drowning patient with pulmonary edema?
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In the case of suspected decompression sickness, which of the following factors should be documented?
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What initial IV fluid volume is recommended for adults experiencing decompression sickness?
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What should be assessed frequently when administering normal saline to a patient?
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What is a contraindication for using CPAP in a non-fatal drowning situation?
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What is the maximum volume of IV/IO fluid that can be given to a pediatric patient experiencing hypotension?
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What is the primary treatment approach for a patient experiencing heat stroke?
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Which of the following characteristics describes Carbon Monoxide (CO)?
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What is the critical SpCO level at which oxygen should be administered in the presence of symptoms?
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Which of the following conditions is a contraindication for CPAP treatment?
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What should be done if a patient is suspected to have cyanide exposure?
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Which symptom is NOT typically associated with cyanide exposure?
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How should the Cyanokit be prepared for administration?
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What action should be taken for a patient exposed to carbon monoxide with a normal pulse oximetry reading?
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What is the recommended amount of DuoDote injections for a patient experiencing severe organophosphate poisoning with symptoms developing rapidly?
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When should specific precautions be exercised during assessment and treatment?
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Which symptom indicates a patient may have mild organophosphate poisoning?
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What type of patient requires a continuous SpCO reading when exposed to carbon monoxide?
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Which of the following is a symptom that indicates a patient may be suffering from decompression sickness?
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What is the appropriate action to take when transporting a patient suspected of decompression sickness?
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For a pediatric patient experiencing non-fatal drowning, what is the recommended volume of normal saline to administer?
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What critical information should be obtained during the history of a dive for a patient diagnosed with decompression sickness?
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Which of the following statements regarding the treatment of non-fatal drowning is inaccurate?
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What is a key precaution when treating patients with significant coronary heart disease?
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Which of the following symptoms would indicate the need for immediate oxygen administration at 15 LPM via NRB for a patient with suspected carbon monoxide exposure?
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In cases of suspected severe organophosphate poisoning, what is the initial dose of Atropine for adult patients experiencing severe symptoms within 10 minutes?
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When managing a pediatric patient exposed to cyanide, what is the priority intervention after providing oxygen?
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What characteristic of carbon monoxide (CO) contributes to its danger in toxic exposure situations?
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Which of the following is the correct positioning for a patient suspected of decompression sickness during transport?
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What is the recommended initial volume of normal saline for an adult experiencing decompression sickness?
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In what situation should cold water immersion be applied during the treatment of non-fatal drowning?
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What is the maximum saline infusion rate to be used if a patient experiences shortness of breath during normal saline administration?
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Which of the following actions is essential to take when caring for a patient with decompression sickness before transport?
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Which statement best reflects the handling of a patient exposed to carbon monoxide who presents with altered mental status?
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What is the correct action for pediatric patients with hypotension if initial fluid resuscitation does not improve their condition?
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In the event of confirmed cyanide exposure, what is a key precaution to take when administering the Cyanokit?
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Which symptom combination indicates a serious concern for organophosphate poisoning?
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When treating a patient with suspected organophosphate poisoning, what is the minimum dose of Atropine administered for mild symptoms?
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Study Notes
Decompression Sickness
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Consider any patient with stroke-like symptoms, visual disturbances, joint pain, AMS, paralysis or weakness, numbness/tingling, or bowel/bladder dysfunction who has used SCUBA gear or compressed air within the last two days as having decompression sickness.
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Transport to St. Mary’s or Mercy’s Hyperbaric Chamber if available.
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If unavailable transport to the closest ED.
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Contact DAN at (919) 684-9111 for medical consultation.
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Follow treatment recommendations from DAN.
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Document all treatment and the representative's name for the ePCR report.
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Try to determine the depth of dives, air mixture type in tanks, number of dives, and interval between dives.
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Bring all dive equipment to the hospital.
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Transport patient in a supine position
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Administer 15 LPM oxygen via NRB regardless of SpO2.
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Administer 500mL normal saline IV/IO for adults, regardless of blood pressure.
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Administer 20mL/kg normal saline IV/IO for pediatrics, regardless of blood pressure.
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Administer 10 mL/kg normal saline IV/IO for newborns.
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Assess lung sounds frequently.
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If patient has SOB, decreased breath sounds, or coughing blood, decrease fluids to a KVO rate
Non-Fatal Drowning
- Consider selective spinal precautions in the presence of trauma (e.g., diving, rough surf, vehicle accident with subsequent submersion, etc.)
- Transport all non-fatal drowning patients to the hospital.
- Apply CPAP (10 cm H2O) for pulmonary edema secondary to near drowning without hypotension.
- Contraindications: SBP <90, temperature 103 degrees Fahrenheit or altered mental status.
- Apply ice packs to the axilla and groin area.
- Immerse patient in cold water (if available) on scene until core temperature is below 102 degrees Fahrenheit.
- Administer 1L normal saline IV/IO for adults, titrate to desired effect.
- Assess lung sounds and BP frequently. May repeat 1x, prn.
- Caution: take extreme care when treating patients with significant coronary heart disease, CHF, and renal failure.
- Administer 20mL/kg normal saline IV/IO for pediatrics, assess lung sounds and BP frequently.
- May repeat 2x prn, for age appropriate hypotension.
Heat Emergencies
- "Cool first, transport second" when treating heat stroke
Carbon Monoxide Exposure
- Carbon monoxide is a chemical asphyxiant, colorless, odorless, tasteless, and slightly less dense than air.
- Toxic to humans at concentrations above 35 ppm.
- Lower doses can be harmful due to a cumulative effect.
- Patients exposed to carbon monoxide (smoke inhalation, etc.) require a full head to toe patient examination including SpCO monitoring with the rainbow sensor.
- All crew members during rescue operations shall wear their SCBA if the patient is in a hazardous environment.
- Consider Cyanide Exposure. Refer to the "Cyanide Exposure" protocol, if applicable
- Apply a rainbow sensor and obtain continuous SpCO readings.
- Administer 15 LPM oxygen via NRB regardless of SpO2, unless the patient requires ventilatory support.
- If SpCO is >20% and the patient presents with headache, nausea/vomiting, dizziness, altered mental status, chest pain, dyspnea, visual disturbances, seizures, syncope, or SBP <90 mmHg, administer CPAP at 5 cm H2O for a maximum of 90 minutes.
- Contraindications: Patients without spontaneous respirations, patients with a decreased LOC (lethargic), patients < 30 kg.
- Transport to St. Mary’s or Mercy’s Hyperbaric Chamber (encode prior to transport to confirm availability).
- If unavailable, transport to the closest ED.
- Patients with CO exposures can have normal pulse oximetry readings and still be hypoxic.
- Strong consideration for hyperbaric treatment should be given to all pediatric and obstetrical patients with confirmed CO exposures due to their higher susceptibility to the effects of CO exposures regardless of SpCO level or symptoms.
Cyanide Exposure
- Cyanide exposure may result from inhalation, ingestion, or absorption from various cyanide containing compounds, including exposure to fire or smoke in an enclosed space.
- Direct cyanide exposure (non-smoke inhalation) is a Hazardous Materials Incident.
- Consider Carbon Monoxide Exposure. Refer to the "Carbon Monoxide Exposure" protocol, if applicable.
- Administer 15 LPM oxygen via NRB regardless of SpO2, unless the patient requires ventilatory support.
- For confirmed or suspected cyanide exposure, administer Cyanokit as follows:
- Reconstitute 5g vial by adding 200 mL of normal saline to the vial by using the transfer spike. With the vial in the upright position, fill to the "fill line."
- Mix the solution by rocking or rotating the vial for 30 seconds. DO NOT SHAKE.
- Use vented IV tubing and infuse as indicated below.
- Adult: 5g IV/IO, infused over 10-15 minutes, 5gtts/sec (broken infusion stream). May repeat 1x prn.
- Pediatric: Refer to Handtevy system for preparation and dosing. May repeat 1x prn.
- Administer Cyanokit through a separate/dedicated IV/IO line.
- Transport to St. Mary’s or Mercy’s Hyperbaric Chamber (encode prior to transport to confirm availability).
- If unavailable, transport to the closest ED.
Organophosphate Poisoning
- Contact the Florida Poison Information Center: 1-800-222-1222 for organophosphate poisoning.
- Mild poisoning symptoms: miosis, excessive tearing, salivation, runny nose, chest tightness, difficulty breathing, wheezing, muscle twitching, nausea and vomiting, stomach cramps, tachycardia, or bradycardia.
- Severe poisoning symptoms: Strange/confused behavior, severe difficulty breathing, secretions from the lungs or airway, severe muscle twitching, urination, defecation, seizures, or unconsciousness.
- For two or more mild symptoms:
- Adult: Administer 2mg atropine IV/IO.
- Pediatric: Administer 0.05mg/kg atropine IV/IO.
- For severe symptoms developing within 10 minutes:
- Adult: Administer 4mg atropine IV/IO, followed by 1 DuoDote Injection into mid-lateral thigh. If severe symptoms develop within 15 minutes, administer 2 additional doses of DuoDote in rapid succession for a total of 3 DuoDote Injections.
- Pediatric: Administer 0.05mg/kg atropine IV/IO. Repeat every 20-30 minutes PRN for continued symptoms.
- For severe symptoms:
- Adult: Administer 6mg atropine IV/IO, followed by 3 DuoDote Injections into mid-lateral thigh in rapid succession.
- Pediatric: Administer 0.05mg/kg atropine IV/IO. Repeat every 20-30 minutes PRN for continued symptoms.
- If patient is actively seizing: Refer to Seizure Protocol.
Decompression Sickness
- Consider decompression sickness in any patient who has used SCUBA gear or compressed air within 48 hours and presents with stroke-like symptoms, visual disturbances, joint pain, altered mental status (AMS), paralysis or weakness, numbness/tingling, or bowel/bladder dysfunction.
- Transport to St. Mary's or Mercy's Hyperbaric Chamber if available.
- Contact DAN (Diver Alert Network) at (919) 684-9111 for medical consultation.
- Treatment recommendations from DAN should be followed and documented on the ePCR Report.
- Obtain an accurate history of the dive, including depth, air mixture in tanks, number of dives, and interval between dives.
- Bring all dive equipment to the hospital.
- Transport the patient in a supine position.
- Administer oxygen at 15 LPM via non-rebreather mask (NRB) regardless of SpO2.
- Administer normal saline: 500 mL IV/IO for adults and 20 mL/kg IV/IO for pediatrics and 10 mL/kg IV/IO for newborns.
- Frequently assess lung sounds.
- Decrease fluids to keep vein open (KVO) rate if the patient experiences shortness of breath, decreased breath sounds, or coughing blood.
Non-Fatal Drowning
- Consider selective spinal precautions in the presence of trauma.
- Transport all non-fatal drowning patients to a hospital.
- Administer continuous positive airway pressure (CPAP) at 10 cm H2O for pulmonary edema in near-drowning victims without hypotension.
- Contraindications for CPAP: systolic blood pressure (SBP) less than 90 mmHg, temperature exceeding 103 degrees Fahrenheit, or altered mental status.
- Apply ice packs to the axilla and groin area.
- Maintain cold water immersion if available until the core temperature reaches 102 degrees Fahrenheit.
- Administer normal saline (cold preferred if available): 1 L IV/IO for adults, titrated to desired effect, repeating once as needed.
- Administer normal saline (cold preferred if available) to pediatrics: 20 mL/kg IV/IO, repeating twice as needed for age-appropriate hypotension.
Heat Emergencies
- For heat stroke, cool the patient first and then transport.
Carbon Monoxide Exposure
- Carbon monoxide (CO) is a colorless, odorless, tasteless, and toxic gas.
- CO concentrations above 35 parts per million (ppm) are toxic to humans.
- Lower doses of CO can be harmful due to a cumulative effect.
- Conduct a full head-to-toe patient examination including SpCO monitoring with the rainbow sensor.
- Wear SCBA during rescue operations if the patient is in a hazardous environment.
- Consider cyanide exposure and refer to the "Cyanide Exposure" protocol if applicable.
- Apply a rainbow sensor and obtain continuous SpCO readings.
- Administer oxygen at 15 LPM via NRB regardless of SpO2, unless the patient requires ventilatory support.
- If SpCO is greater than 20% and the patient presents with headache, nausea/vomiting, dizziness, altered mental status, chest pain, dyspnea, visual disturbances, seizures, or syncope, and SBP is less than 90 mmHg then consider hyperbaric treatment.
- Contraindications for CPAP: dyspnea, visual disturbances, seizures, syncope, SBP less than 90 mmHg, no spontaneous respirations, decreased level of consciousness (lethargic), patients under 30 kg.
- Transport to St. Mary's or Mercy's Hyperbaric Chamber if available.
- If unavailable, transport to the closest ED.
- Patients with CO exposures can have normal pulse oximetry readings and still be hypoxic.
- Strong consideration for hyperbaric treatment should be given to all pediatric and obstetric patients with confirmed CO exposures due to their higher susceptibility to the effects of CO exposures, regardless of SpCO level or symptoms.
Cyanide Exposure
- Cyanide exposures can result from inhalation, ingestion or absorption from various cyanide containing compounds, including fire or smoke in an enclosed space.
- Direct cyanide exposure (non-smoke inhalation) is a Hazardous Materials Incident.
- Consider Carbon Monoxide Exposure.
- Refer to the "Carbon Monoxide Exposure" protocol if applicable.
- Administer oxygen at 15 LPM via NRB regardless of SpO2, unless the patient requires ventilatory support.
- For Cyanokit administration:
- Reconstitute the 5g vial by adding 200 mL of normal saline using the transfer spike. Fill to the “fill line”.
- Mix the solution by rocking or rotating the vial for 30 seconds. Do not shake.
- Use vented IV tubing and infuse as indicated below.
- For adults:
- Infuse 5g IV/IO over 10-15 minutes at a rate of 5gtts/sec (broken infusion stream)
- May repeat once as needed.
- Administer through a separate IV/IO line.
- For pediatrics:
- Refer to the Handtevy system for preparation and dosing.
- May repeat once as needed.
- Administer through a separate IV/IO line.
- Transport to St. Mary's or Mercy's Hyperbaric Chamber if available.
- Transportation to the closest ED if unavailable.
Organophosphate Poisoning
- Contact the Florida Poison Information Center at 1-800-222-1222.
- For mild poisoning:
- If the patient experiences two or more mild symptoms, administer atropine 2mg IV/IO.
- Mild symptoms include miosis, excessive tearing, salivation and runny nose, chest tightness, difficulty breathing, wheezing, muscle twitching, nausea and vomiting, stomach cramps, tachycardia, or bradycardia.
- For severe poisoning:
- If severe symptoms develop within 10 minutes, administer atropine 4mg IV/IO and 1 DuoDote Injection into the mid-lateral thigh.
- If severe symptoms develop within 15 minutes, administer 2 additional DuoDote injections in rapid succession for a total of 3 DuoDote injections.
- If severe symptoms develop, administer atropine 6mg IV/IO and 3 DuoDote injections into the mid-lateral thigh in rapid succession.
- Severe symptoms include: strange/confused behavior, severe difficulty breathing, secretions from the lungs or airway, severe muscle twitching, urination, defecation, seizures, or unconsciousness.
- For pediatrics:
- For symptomatic (mild or severe) poisoning: administer atropine 0.05mg/kg IV/IO.
- Repeat every 20-30 minutes as needed for continued symptoms.
- For seizures:
- Refer to Seizure Protocol.
Decompression Sickness
- Signs and Symptoms: Stroke-like symptoms, visual disturbances, joint pain, altered mental status, paralysis or weakness, numbness/tingling, bowel/bladder dysfunction.
- Treatment: Transport patient to a hyperbaric chamber if available.
- Important: Obtain dive history, depth, air mixture, number of dives, interval between dives, and bring all dive equipment to the hospital.
- Positioning: Transport in a supine position.
- Oxygen: 15 LPM via non-rebreather mask (NRB) regardless of SpO2.
- Fluid Management: Administer 500mL normal saline IV/IO for adults and 20mL/kg IV/IO for pediatrics. Monitor lung sounds closely and adjust fluid rate if needed.
Non-Fatal Drowning
- Consider: Selective spinal precautions if trauma is involved (e.g., diving, rough surf, vehicle accident with subsequent submersion).
- Transport: All non-fatal drowning patients MUST BE TRANSPORTED to the hospital.
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Treatment:
- Apply CPAP (10 cm H2O) to patients with pulmonary edema secondary to near-drowning, but without hypotension.
- Administer cold normal saline (1L for adults, 20mL/kg for pediatrics).
- Apply ice packs to axilla and groin area. Cold water immersion (if available) until core temperature is below 102°F.
Heat Emergencies
- Remember: "Cool first, transport second" when treating heat stroke.
Carbon Monoxide Exposure
- Properties: Carbon monoxide is a colorless, odorless, and tasteless gas that is slightly less dense than air. It is toxic to humans in concentrations above 35 parts per million (ppm).
- Treatment: Apply a rainbow sensor and obtain continuous SpCO readings. Administer 15 LPM via NRB unless the patient requires ventilatory support.
- Hyperbaric Considerations: Strong consideration for hyperbaric oxygen therapy should be given to all pediatric and obstetrical patients with confirmed CO exposures due to their higher susceptibility.
Cyanide Exposure
- Signs and Symptoms: Altered mental status, pupil dilation, general weakness, confusion, bizarre behavior, excessive sleepiness.
- Treatment: Administer oxygen 15 LPM via NRB. Administer Cyanokit as indicated per adult and pediatric protocols.
Organophosphate Poisoning
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Symptoms:
- Mild: Miosis, excessive tearing, salivation, runny nose, chest tightness, difficulty breathing, wheezing, muscle twitching, nausea, vomiting, stomach cramps, tachycardia, bradycardia.
- Severe: Strange/confused behavior, severe difficulty breathing, lung or airway secretions, severe muscle twitching, urination, defecation, seizures, unconsciousness.
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Treatment:
- Mild: Administer atropine (2mg IV/IO) for two or more mild symptoms.
- Severe: Administer atropine (6mg IV/IO) for severe symptoms and 3 DuoDote injections into the mid-lateral thigh.
- Pediatric: Administer atropine (0.05mg/kg IV/IO) for mild or severe symptoms and repeat every 20-30 minutes PRN.
- Important: Contact the Florida Poison Information Center (1-800-222-1222) for organophosphate poisoning.
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Description
This quiz covers the essential steps for managing decompression sickness in patients with recent SCUBA diving history. It highlights important symptoms, treatment protocols, and the transportation procedures to a hyperbaric chamber. Familiarity with the critical details can enhance patient care and response effectiveness.
