Program Overview

Program Overview

COURSE INTRODUCTION AND REGISTRATION
T his lecture will present details of the Undersea and Medical Society (UHMS), The National Board of Hyperbaric Medical Technicians (NBDHMT),The Baromedical Nurses Association (BNA), and Hyperbarics International, Inc. and the International Board of Undersea Medicine. At the end of this lecture, students should be familiar with the history of these organizations and what these organizations can do for them as applied to diving and hyperbaric medicine.

INTRODUCTION OF HYPERBARIC CHAMBERS
T his presentation will include information about the various methods of administering hyperbaric oxygen therapy to diving and clinical patients. Examples of various monoplace, multi-place, and transportation chambers will be noted. The advantages and disadvantages of each chamber will be discussed, both in the treatment of divers and hyperbaric oxygen therapy patients. At completion of this lecture the students should have a good overview of the various types of hyperbaric chambers, off-shore or hospital based in current use around the world.

HISTORY OF DIVING AND HYPERBARIC MEDICINE
This lecture will present details of the history of diving and hyperbaric medicine from ancient through modern times. The development of the current dive and diver treatment tables with information pertinent to diving medicine as these tables are used today. Upon the completion of this lecture, students should be thoroughly familiar with the history of treatment tables, (air, oxygen and therapy gas, mixed gas) and other treatment tables most commonly used thoughout the world.

BASIC PHYSICS, PHYSIOLOGY AND GAS TABLES
This lecture is designed to give gas laws pertinent to the field of diving and hyperbaric medicine. The physics involved in the gas laws and their relevance to the physiology of the human body will be detailed. Calculations of pressure and volume changes will be used to illustrate the gas laws, and the pressure/volume effects on physiology and pathophysiology of diving accidents will be used during the lecture. At the completion of the lecture, the student should have a good grasp of physics and physiology as related to diving and hyperbaric medicine, and have a good working knowledge of the physical requirements for divers. The student would also be able to perform volume/pressure/depth calculations.

BAROTRAUMA, EARS, SINUSES, AND LUNGS
(DIRECT EFFECT OF PRESSURE)
During this presentation, information regarding the effects of pressure changes of various body structures will be noted. The physics, physiology, pathophysiology and medical aspects leading to Arterial Gas Embolism(AGE), Pneumomediastinum, Subcutaneous Emphysema and Pneumothorax will be presented. At the end of this program the student should be able to recognize the signs/symptoms, stabilization and field management required, treatment and treatment tables, medications and medical reevaluation of these persons for the future hyperbaric exposures.

PHYSICAL FITNESS FOR DIVING
An overview of the physical requirements for divers will be presented during this lecture. Various physical conditions and medical problems which present hazards to diving will be presented. At the completion of this program, the students should be able to give recommendations as to whom is qualified or disqualified from diving.

DECOMPRESSION SICKNESS CAUSES, CLINICALMANIFESTATIONSS
and DIAGNOSIS
The student will be taught the various physiologic considerations found in the development of DCS. The predisposition of certain tissues toward DCS, especially the spinal cord andcentrall nervous system will be stressed. Clinical Manifestations and diagnosis of DCS will be discussed. At the end of this session, the student should have a thorough knowledge of the causes, diagnosis and the treatment of DCS.

SCENE MANAGEMENT OF DCS AND EXTRA ALVEOLAR AIR
The early recognition, stabilization, first aid evacuation procedures importance of the use of oxygen, oxygen delivery systems and medications will be taught for the on-site management of DCS, embolisms,emphysema'ss and pneumothorax. At the completion of this program, the students should be able to demonstrate working knowledge for the field management of DCS and AGE. The student should also be able to show knowledge in the methods of transportation for diving related trauma, especially air evacuation problems.

OXYGEN TOXICITY AND OXYGEN USE
(OPERATIONAL and THERAPY)
The development of both central and pulmonary oxygen toxicity will be noted. The underlying pathophysiology will be stressed for the operational/therapy use to prevent pulmonary oxygen toxicity for diving accident victims, observers and other persons subjected to the hyperbaric environment. Also stressed will be thepreventionn of CNS 02 toxicity for both patients and observers. Various methods for administering oxygen at the scene of a dive accident and during medicaltherapeuticss will bediscussedd and the advantages/disadvantages of each methods of administration will be noted, such as; masks, ventilators, hood systems, multi-place vs. mono-place chambers. At the completion of this program, the students should have a thorough working knowledge ofoxygenn use and complications.

DIVE TABLES AND TREATMENT TABLES DEVELOPMENT
During this lecture, we will stress the historic development of the dive and treatment tables over the years. The physiologic basis for the development of the dive treatment will be stressed, as will treatment table concepts andphilosophiess using USN, NOAA, USAF, Foreign andCommerciall tables, for the purpose of treating saturation and non-saturation divers. A review of the clinical HBO tables will also be discussed. The student should develop a thorough working knowledge of the dive and treatment tables in current use throughout the world.

MEDICATIONS IN DIVING AND HYPERBARIC ENVIRONMENTS
A listing of the common medications use by both sport andcommerciall divers, including medications used in the hyperbaric oxygen therapy and field management will be stressed. The effects of pressure and oxygen with medications, and the effect of the medication on the patient or diver will be noted. At the completion of the program, the students should have a working knowledge of common medications used in hyperbaric, diving and field management of diving accidents, and their contradictions for use.

CRITICAL CARE IN THE HYPERBARIC ENVIRONMENT
An overview of the methods of treating critically ill or injured patients in the hyperbaric chamber will be presented. Various sorts of equipment, supplies and methods of the treatment will be outlined, with ample hands-on use of this equipment in the hyperbaric environment. At the completion of this program, the student will have a good overview of the types of critical care management that can be performed in the hyperbaric chamber.

NITROX AND OTHER MIXED GASES FOR RECOMPRESSION THERAPY
An overview of the use of Nitrox and Heliox gas mixtures for therapy purposes. The pro and cons of these mixes will be stressed, both for operational and therapy advantages. At the completion of this program the student should be able to outline the advantages/disadvantages of NITROX or HELIOX for operational or therapy use. Theyshouldl alsodemonstratee a superficial knowledge of the other types of mixed gases in use incommerciall diving and therapy.

MULI-PLACE RECOMPRESSION CHAMBER LIFE SUPPORT SYSTEMS
A general overview of multi-place recompression chambers life-support systems will be presented with ample hands-on work with these systems. Life support systems training will include; Carbon Dioxide and oxygen life support ranges and duration in any hyperbaric compartment Chamber ventilation rate requirements, safety and decompression procedures forattendantss from hyperbaric treatment cylinderduration'ss of oxygen, air, heliox and gas storage systems. At the completion of this program, the student should have the knowledge to operate gas supply requirements,duration'ss and life support ranges of patients in the chamber. They should have the knowledge to work as a team member to insure the adequate and successful treatment of all patients and observers that enter under their supervision.

RECOMPRESSION CHAMBER SAFETY
This program will include presentations pertaining to chamber safety. Stressed will be chamber fire safety, with films showing chamber fires at variousdepthss. Also electrical, oxygen, pressure integrity, equipment and operational safety standards/codes; National Fire Protection Agency NAPAA), Pressure Vessel for Human Occupancy pHO),Americann Society of Mechanical Engineers SAMEE), ANSI,USGG andOOTAA. AT the completion of this program each student will have the knowledge to insure each of the codes are applied as needed for his facility.

PRACTICAL USE OF HYPERBARIC CHAMBERS
During this program each student will apply all knowledge as presented, during practical sessions each afternoon. Each daytherer will be three to four hours of chamber operations, to employ all equipment, techniques, medical equipment, gases, venting, air supply and scenarios of critical patients. Chambers dives will range from 30 to 130 fsw during this program to simulate locking observers in-out and taking advantage of the operational aspects of Nitrox. This session will teach those students total chamber operation. Taking care of critical patients inside the hyperbaric environment. Physicians should be able to perform the task of Diving MedicaOfficerer (DMO). At the completion of this program, all other Allied Medical Personnel should be able to perform the duties of a Diving Medical Technician (DMT) and consult directly with DMO's from the field for the care and treatment of a diving accident victim in a field situation.

INTRODUCTION TO HYPERBARIC OXYGEN INDICATIONS::
Approved uses

Carbon Monoxide Poisoning and Smoke Inhalations Carbon Monoxide complicated by Cyanide Poisoning
Clostridial Myonecrosis (gas gangrene
Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
Enhancemnt of Healing in Selected Problems
Exceptional Blood Loss (anemia)
Necrotizing Soft Tissue Infections (subcutaneous tissues, Muscle, fascia)
Osteomyelitis (refractory)
Systemic or Local Factors that affect Immune Surveillance, Metabolism and Local Vascularity
Radiation Tissue Damage (osteoradionecrosis)
Skin Grafts and Flaps (compromised)
Thermal Burns
Adjunctive Hyperbaric Oxygen in Intercranial Abscess

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A Unique Experience
Hyperbarics International, Inc.
522-A Caribbean Drive, Key Largo, Florida, 33037 USA
(305) 451 2551, fax (305) 451 5765

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