Richard B the EMT Posted December 17, 2009 Posted December 17, 2009 (edited) Some basic questions by me: Was it a shark attack? Was it a commercial diver job related injury, suffered underwater? Did the diver surface too quickly, thereby causing him/herself a case of "The Bends"/"Caissons Disease"/"Barometric Trauma"? If anything related to that last, how low can the pilot fly the helicopter safely, as not to aggravate the condition? chbare must have posted even as I was still typing. Edited December 17, 2009 by Richard B the EMT
chbare Posted December 17, 2009 Author Posted December 17, 2009 Not a shark attack. Non commercial diver. Take care, chbare.
tniuqs Posted December 17, 2009 Posted December 17, 2009 A109 E SWEET ! So we have room to move and work and no turbulence ... I wish I would be thinking: 1: Drowning/ Near Drowning. 2: Box Jellyfish, Stone Fish, Irukandji,(sp) Portuguese Man o War ? 3: Bent or Pulmonary Emboli, as not a professional diver. 4: Hypothermia ? Have WE made contact with patient and are we prepared with PPE if the case of the marine critters are still on the patient? Any history to to event: Like lhat is being done in the back of the truck ... is patient awake, is the pt intubated, wearing a scuba or sting resistant suit, whats being done for this patient ? cheers 1
chbare Posted December 17, 2009 Author Posted December 17, 2009 A109 E SWEET ! So we have room to move and work and no turbulence ... I wish I would be thinking: 1: Drowning/ Near Drowning. 2: Box Jellyfish, Stone Fish, Irukandji,(sp) Portuguese Man o War ? 3: Bent or Pulmonary Emboli, as not a professional diver. 4: Hypothermia ? Have WE made contact with patient and are we prepared with PPE if the case of the marine critters are still on the patient? You make contact, no history of exposure to aquatic wildlife. Any history to to event: Like lhat is being done in the back of the truck ... is patient awake, is the pt intubated, wearing a scuba or sting resistant suit, whats being done for this patient ? Patient is awake, out of his diving uniform, an in the left lateral recumbent position. EMS have placed a pulse oximeter, cardiac monitoring, NIBP, and have the patient on a NRM at 15 LPM. The patient is at least oriented to person as he responds to his name with moaning and complaints of "pain all over my body." His girlfriend is present, but EMS neglected to bring his dive partner. cheers Take care, chbare.
rock_shoes Posted December 17, 2009 Posted December 17, 2009 Patient is awake, out of his diving uniform, an in the left lateral recumbent position. EMS have placed a pulse oximeter, cardiac monitoring, NIBP, and have the patient on a NRM at 15 LPM. The patient is at least oriented to person as he responds to his name with moaning and complaints of "pain all over my body." His girlfriend is present, but EMS neglected to bring his dive partner. Since the pulse ox etc. are already in place, what do they say? Any signs of trauma of any kind? How is the patient's work of breathing? Lung sounds? Are we able to find out how deep this man was diving? What was his rate of ascent? What mix was he using in his tank? How long was he underwater for? Did his partner come up at a similair rate of ascent? Has his partner experienced any symptoms? What is the transport time to definitive care by ground? How low can your pilot fly safely? If a patient is experiencing or progessing to "the bends" and or nitrogen narcosis any significant gain in elevation is a serious concern.
chbare Posted December 17, 2009 Author Posted December 17, 2009 Since the pulse ox etc. are already in place, what do they say? Any signs of trauma of any kind? P-110, R-24, BP-180/100, SPO2-100%, no overt signs of trauma How is the patient's work of breathing? Lung sounds? You note increased WOB, lung sounds are diminished in the bases bilat with wet sounds to the LLL with inhalation and exhalation. Are we able to find out how deep this man was diving? What was his rate of ascent? He Planned to dive to 450 fsw ( ~137.2 meters). Planned for a very rapid descent to explore a ship wreck with a bottom time of a few minutes and a slow ascent with multiple planned decompression stops. All planned on tables and dive computers. What mix was he using in his tank? How long was he underwater for? He states he planned to utilise trimix. EMS has his equipment. Total dive time of several hours due to the long deco phase of the ascent. Did his partner come up at a similair rate of ascent? Has his partner experienced any symptoms? Yes, no problems with his partner however. What is the transport time to definitive care by ground? How low can your pilot fly safely? If a patient is experiencing or progessing to "the bends" and or nitrogen narcosis any significant gain in elevation is a serious concern. Ground will be at least 30 minutes to the closest monoplace chamber. Take care, chbare.
joesph Posted December 18, 2009 Posted December 18, 2009 (edited) OK first can we take the helo scouting for elk? Secondly if we go in the direction of the bends then we are going to have to fly low not to aggravate the situation more. gotta due some research to be productive at this level but i'm stickin with the scouting for elk plan Edited December 18, 2009 by joesph
chbare Posted December 18, 2009 Author Posted December 18, 2009 OK first can we take the helo scouting for elk? Secondly if we go in the direction of the bends then we are going to have to fly low not to aggravate the situation more. Potential consideration, look at times and the patient's condition, and make a judgment call. gotta due some research to be productive at this level but i'm stickin with the scouting for elk plan Are there any other things we need to assess and find out, or are you guys satisfied enough with the current amount of information to make a diagnosis and pursue a treatment pathway? Take care, chbare.
mobey Posted December 18, 2009 Posted December 18, 2009 Recent trauma? Temp? 12 lead? Medical history?
chbare Posted December 18, 2009 Author Posted December 18, 2009 No trauma. Core temp: 91F (~32.7 C). No past medical or surgical history. Take care, chbare.
Recommended Posts