Undersea Medical Team Training Program
DATES:
Year 2008
Jan. 21-25, Feb. 4-8, Mar.10-14, Apr. 7-11, May 5-9, June 9-13, July 21-25, Aug. 4-8, Sep. 15-19, Oct 13-17, Nov. 17-21, Dec.15-19
TITLE: Advanced Recompression Therapy of Diving Accidents with Multi-Place Recompression Chamber Operations, Chamber Life Support Systems, Gases and Medical Equipment in the Hyperbaric Environment.
FACULTY: Dick Rutkowski, Program Director , and James W. Lowenherz, M.D. Medical Director
FEE: $845.00 (includes CME's, Text Materials and Manuals). CEU's approved for all medical personnel. NAUI CEU's available
SITE/CONTACT: DICK RUTKOWSKI Hyperbarics International, Inc. 522-A Caribbean Drive . Key Largo, FL 33037 (305) 451-2551. , FAX (305) 451-5765
CME/CEU CREDITS: 40 Hours CME, Category I, AMA through UHMS for Physicians, NBDHMT/IBUM Module 16, for Allied Medical Personnel to become DMTs. Recertification hours for NBDHMT/IBUM CEUs Available for medical and NAUI.
DESCRIPTION: This program is designed to teach physicians, allied medical, dive supervisors and dive rescue personnel advanced chamber and medical techniques for medically evaluating dive candidates, early recognition of the signs/symptoms of DCS and EAA, field management (first aid), evacuation and treatment of diving accident victims, pharmaceutical agents, total recompression chamber operations and the use of gases during hyperbaric exposures and medical equipment in the hyperbaric environment. These techniques include saturation and non-saturation treatment procedures for divers, patients and observers. This program will convey to diving medical officers (physicians) the philosophies of the physics, physiology, pathophysiology and the medical aspects of compressing patients and observers within the hyperbaric environment ensuring the CNS/Pulmonary and Decompression Clocks balance out for safe treatment protocol. This program is an excellent opportunity for all dive personnel to learn advanced diving physics, physiology and the medical aspects of proper treatment.
Advanced Undersea Medical Team Training Program for all Medical, Chamber and Dive Supervisors, and Dive Rescue Personnel
This 40 hour advanced undersea medical training program, is designed to convey pertinent medical and operational information to those medical personnel who need to evaluate, treat and supervise recompression therapy of diving accidents; diving or chamber operations in the field or hospital based multi or dual place chambers. Every patient and observer placed in the chamber is a diver. This program will help everyone to understand the physiology of balancing out the central nervous system oxygen toxicity, pulmonary oxygen toxicity and decompression clocks for the best outcome of the patient and observer, especially at depths greater than 45 FSW where these clocks are running faster.
Program curriculum covers:
Course Introduction and Registration
Introduction to Hyperbaric Chambers: multi, dual and mono place
Calculation of Pressure
Atmosphere Absolute (ATA) Ambient BAR mmHq PSI FSW Bottom Pressures Overbottom Pressures Hydrostatic Pneumatic Partial Pressures Cylinder Pressure Conversions
Mathematical Formulas of Dalton's Law
Dalton's Law as Applied to Calculations of Partial Pressures/fractions of Gases Depths for Using Gases Ensuring the Safe Physiological Limits of All Treatment Gases Decompression Gases: air, oxygen, nitrox, etc. ... for patients and observers
Barotrauma of Ears and Sinuses
Barotrauma of the Lungs, Extra Alveolar Air Syndrome (E.A.A.S.)Sinus Squeeze Inner Ear and Middle Ear Trauma Alternobaric Vertigo Oval and Round Window Rupture Tympanic Membrane Vestibular 8th Nerve DCS Hemorrhage Along the 8th Nerve
Extra Alveolar AirArterial Gas Embolism (AGE) Tension Pneumothorax Pneumopericardium Pneumomediastinum Subcutaneous Emphysema
Scene Management of E.A.A.Physical Requirements of Diving Candidates Factors that Predispose to E.A.A. Primary Medical Operational Environmental Factors
Treatment of E.A.A.On the Scene First Aid Advantages and Disadvantages of the Head Down/Left Lateral Position The Use of Oxygen and Other Emergency Medical Procedures for Medical and Lay Personnel
Treatment Protocol for Diving Medical Officers (DMO's) USN, Commercial, NOAA, USAF and Foreign Treatment Tables Philosophies Medications and Drugs Fluids Critical Care Management Post Treatment Evaluation Retreatments
Physiological Implications of Oxygen and Oxygen Life Support Ranges for Diving and Recompression Therapy (Patient/Observer)
(Recompression Chamber Manual page 33-44)
Oxygen Life Support Limits (Operational/Therapeutical)
Central Nervous System Oxygen Toxicity (CNS O2 Toxicity)Underlying Pathophysiology of CNS Oxygen Toxicity Pulmonary Oxygen Toxicity Hypoxia Limits as Applied to Patients and Observers
Pros and Cons of In-Water Use of Oxygen for Therapy and DecompressionPathophysiology of the Signs and Symptoms Underlying Mechanisms of the Off Phenomenon Oxygen Delivery Systems Ventilation Rate Requirements for Chambers, Hood Systems, Masks and Ventilators Factors That Reduce Tolerance to Oxygen for Patient and Observer Care Oxygen Exposure Limit Tables and Their Use The Use of Oxygen for Decompression of Observers Protocol for Seizures in a Multi, Dual or Mono Chamber
Safety Considerations for Using Oxygen Enriched Air Mixtures for Therapy Oxygen Tolerance Test CNS Oxygen Toxicity and the Oxygen Treatment Tables
Pulmonary Oxygen Toxicity
(Recompression Chamber Manual page 45-59)
Pathophysiology of Pulmonary Oxygen Toxicity
Understanding the Pulmonary O2 Clock for Operational Diving and Therapy
Preventing Damage to the Lungs of Patients and Observers
Using the Unit Pulmonary Toxicity Dose
Determining the percentage of Vital Capacity Decrement at the Dive Site O2 Consumed During the Dive During Decompression Treatment at Dive SiteDetermining the Net Effect of a Specific Duration of Breathing Oxygen at Pressure Converting the UPTD to Percentage of Vital Capacity Decrement (%Vc)
Treatments With or Without ExtensionsEvacuation on O2 Amount of Oxygen Given During
Signs and Symptoms of Pulmonary O2, ToxicityCan Oxygen Be Given on Ward After Treatment? When to Bring Patient Back for Retreatment
Pathophysiology of Pulmonary O2, Toxicity
Arithmetic Method for Predicting Percentage of Vital Capacity Decrement
Pulmonary Symptom Reversal and Restart Times of the Pulmonary O, Clock
Lowering the Partial Pressure of Oxygen on the Pulmonary Clock
Open Circuit Air Closed Circuit Mixed Gas Change Gas Mixtures
Decompression Sickness (DCS)
Physiological Considerations Found in the Development of DCS History of DCS
Factors that Predispose Certain Tissues to DCS
Types, Signs and Symptoms of DCS
Scene Management of DCS
Factors that Contribute to DCS
Clinical Manifestations and Diagnosis of DCSPrimary Medical Operational Environmental
Physiological Basis for Dive Table Development
Critical Care of DCS in Hyperbaric Chamber
Treatment Table Selection for All Types of DCS
Medications for Field and Hyperbaric Treatment of DCS
Fluids Drugs Steroids, Etc.
Medications in Diving and Hyperbaric Environments
Medications and Underlying Diseases that Disqualify Divers
Medications Used in Hyperbaric Therapy (E.A.A. and DCS)
Common Medications Used for Field Management of Diving Accidents
Physical Fitness for Diving
An Overview of the Physical Requirements for Divers
Physical Conditions and Medical Problems Which Present Hazards to Divers and Chamber Observers
Physiological and Operational Implications of Carbon Dioxide (CO2)
(RecompImplicationsber Manual page 65- 78)
Carbon Dioxide Life Support Ranges Maximum PCO, for Patients on 2-3 ATA of O2
Mechanism ofPCO2 and PO2 Contributing to Convulsions
Ventilation Rate Requirements
Ventilation of Respiratory Dead SpaceMulti, Dual and Mono Chambers Hoods, Masks and Ventilators (ACFM vs. SCFM)
How the Mechanical Dead Space or Mechanical Resistance to Breathing Can Contribute to CNS O, Toxicity
Ventilation Rate Requirements for Chamber With or Without Overboard Dump
Continuous and Interrupted Venting Procedures
Venting ACF, SCF and Liters to Ensure Adequate Flow
Chamber Life Support Duration Without Venting Before Physiology Becomes Life Threatening
Note: CO, scrubbers, scrubbing agents and closed circuit systems will be discussed during special advanced programs.
Nitrox Therapy Gas Mixtures (N2/O2)
(Recompression Manual page 79-86)
Why Diving Accident Victims May Require Nitrox
Nitrox MixturesThe Advantages of N2/O2 for Therapy The Advantages of N2/O2, for Observers
Nitrox Tables
Physiological Implications of N2/O2
Avoiding CNS and Pulmonary O2 Toxicity
Nitrox Advantages for Decompression of Observers
Equating a N2/O2 , Observer to the USN Deco Tables
Therapeutical and Operational Advantages for 60/40 Nitrox Mixtures and 50/50 Nitrox Mixtures
Nitrox (N2/O2 )vs. Heliox (He/O2)
Isobaric Bubble Growth
Isobaric Gas Switching Resulting in Super Saturation and Life Threatening Symptoms
Switching to He/O, While Increasing or Decreasing Pressure
Chamber Gas Supply Requirements (Free Flow System)
(Recompression Manual page 89)
Determining Internal Volume of Chamber, Cylinder, Flask in Cubic Feet, Gallons and Liters.
Determining How Many Actual Cubic Feet (ACF) are Required to Pressurize Chamber
Determining Compressor Output (SCF)
Determining Volume of Gas Required to Pressurize Chamber at Least Twice
Determining Primary/Secondary Gas Supply Requirements for Treatment Tables
How CO, Scrubbers Can Assist Primary and Secondary Air Supply
Emergency Procedures for Storing Personnel in Chambers in the Event Primary and Secondary Air Supplies are Lost
Chamber Cylinder Gas Suddenly Required for Masks, Hoods Ventilators (Open Circuit Demand/Free Flow)
(Recompression Chamber Manual page 9)
Determining SCF of Gas to Conduct a Dive Operation in Water or Chamber for All Demand and Free Flow Systems
Determining How Many Cylinders of O, is Needed to Conduct a Treatment or Decompression of Observers
Determining How Many SCF of Air, O, or Nitrox is Required by Mask for Emergency Breathing.
Determining How Many SCF of Air or Nitrox is Required for Observers to Make Bounce Dives in the Chamber
Decompression of Observers from Air or Oxygen Treatment Tables
(Recompression Chamber Manual page 99)
Decompression of Observers from Air or Oxygen Treatment Tables
Pro's and Con's of USN, USAF, NOAA, Civilian and Foreign Treatment Tables
Decompression of Observers
Using Oxygen Using Nitrox Ensuring the Hydrostatic and Off Gassing Components Are Met Using Standard USN Decompression Tables Using "Surface Decompression Oxygen" Using the EAD Concept Staying From One Minute to Two Hours at 165 FSW and Coming Out on a USN O2 TT6 or Extended 6 For 165 to 60 FSW on a USN Air TT4 to 60 FSW, Then Out on USN O2 TT6 or Extended 6
Treatment Tables and Viable Treatment Table Options for DMO's
(Recompression Chamber Manual page 105)
This portion of the program describes how to successfully treat a patient and observer when the patient loses vital signs and it becomes necessary to increase pressure to restore the vital signs. Ideally, we would recompress the patient on a single treatment table. However, it is important to know the next slower table to use to ensure the safety of the patient and observer. The deeper the recompression depth is, the faster the CNS, Pulmonary Oxygen and Decompression Clocks are running, therefore it is necessary to know other treatment table options
(Practical Hands On)
Fluid Management (I.V.'s), Catheters, Suction, E.K.G.'s, Hoods, Ventilators, Masks
Neurological Evaluation
Adjusting Treatment Tables for Reoccurrence of Symptoms
Tension Pneumothorax, Pneumocardium and Pneumomediastinum
Note: Daily hands on use of this equipment and procedures
Pre-Screening Medical Equipment for Hyperbaric Environment
Chamber Life Support Systems
Preventing Chamber Fires
Each participant will receive 2-3 hours hands on use of the recompression chamber each day to practice the following:
Venting Procedures and Requirements
Logs and Timekeeping
Lock-In/Lock-Out Procedures
Use of All Calculations for Gas Supply, Pressures and Venting
Scenarios to Practice Skills Outlined Under Critical Care and Medical Equipment
Numerous Chamber Dives from 30 FSW to 130 FSW Using All Breathing Gases (Air, Oxygen, Nitrox Therapy Gas)
Located on a beautiful deepwater marina in the heart of Key Largo, next to Hyperbarics International, just one hour south of the Miami International Airport. Marina Del Mar is just minutes away from the Atlantic Ocean and the spectacular coral reefs of John Pennekamp Coral Reef State Park and the adjacent Key Largo National Marine Sanctuary. Contact us at
dick@hyperbaricsintl.com or call toll free (800) 451-3483, local or international (305) 451-4107, fax (305) 451 1891. P.O. Box 1050, Key Largo, FL 33037
Critical Care and Medical Equipment in the Hyperbaric
Environment
Protocol for Placing Persons in a Coma or with Life Threatening Vital Signs Under Pressure Protocol for Pre-Screening Patients for Safety Before Placing in Chamber to Prevent Injury
Recompression Chamber Safety
Types of Cleaning Materials, Clothing and Painting for Interior Chamber Safety
Pressure Vessel Integrity
Emergency Breathing Gases and Their Importance
Practical Use of Multi-Place, Multi-Lock Hyperbaric Chambers
Lodging at Marina Del Mar
Course Registration
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A Unique Experience
522-A Caribbean Drive, Key Largo, Florida, 33037 USA
(305) 451 2551, fax (305) 451 5765
Site maintained by Skeeter Bytes Key Largo, Florida, USA.