NOAA Diving Medical Technician 2015 - PDF document

NOAA Diving Medical Technician 2015 NOAA Diving Medical Technician 2015 Morgan Well

s, PhDDr. Ed Kay, MD 2 NOAA Diving Medical Technician 2015 Fitness to Dive Abl

e to do the “work”breathe, swim, SAVE YOU!Not susceptible to barotrauma:e

ar, lung, GINot susceptible to loss of consciousness (drowning): convulsions, insu

lin dependent diabetes, heart blockNot pregnantNo diseases that diving could make w

orse:sinus or middle ear disease, previous labyrinthine window rupture, heart failu

re Not ‘overly’ susceptible to DCIAge?Female gender?Obesity?Menses?Previo

us decompression illness?Fatigue, dehydration?Orthopedic injuries or surgery?Atrial

septal defects, PFO? Adapted from Moon, NOAA Diving Medical Technician 2015 Boyle

s Law Pressure and Volume Inversely Proportional 4 NOAA Diving Medical Technician

2015 SqueezeMIDDLE EAR SQUEEZEEXTERNAL EAR SQUEEZESINUS SQUEEZETOOTH SQUEEZE (BAROD

ONTALGIA)BODY (SUIT) / FACE (MASK) SQUEEZESTOMACH / INTESTINEINNER EAR BAROTRAUMAS

NOAA Diving Medical Technician 2015 Differential Ear PainBarotraumaOtitisDental Abs

cessTMJ SyndromeLymphadenopathyForeign Body or CerumenImpaction Mastoiditis/ Sinusi

tis / Cellulitis 6 NOAA Diving Medical Technician 2015 Class of DrugsDrug Effects

Adverse to DivingAnticoagulantsHemorrhage from Barotraumaor Spinal DCSNarcotics, Ma

rijuana & AlcoholImpaired judgment & problem solving.Aggravation of nitrogen narcos

isTranquillizersImpaired judgment & problem solving.Aggravation of nitrogen narcosi

sAntidepressantsRisk of seizures with Bupropion (Wellbutrin)Decongestants & Antihis

taminesSleepinessnasal rebound congestion.Risk of ear barotrauma and O2Toxicity wit

h pseudoephedrine (Sudafed)Motion sickness drugsSedation, impaired judgment and agg

ravation of nitrogen narcosis.Beta blockersReduced ability to respond to needs of s

tress.ggravate Raynaud'sPhenomenon and asthmaAnti malarialsMefloquine (Lariam) psyc

hological & neurological side effects are similar to symptoms of DCS.Doxycycline ca

uses disabling photosensitivity.SympathomimeticsAmphetamines, methylphenidate and t

o a lesser extent pseudoephedrine (CNS stimulants) increase risk of CNS oxygen toxi

city.Amphetamines can distort or amplify selfconfidencegrandiosity) or increase ris

k of panic during frightening narcosis NOAA Diving Medical Technician 2015 Anatomy

of External Ear 8 NOAA Diving Medical Technician 2015 Anatomy of External Ear Heli

x Tragus Lobule Concha NOAA Diving Medical Technician 2015 Internal Anatomy 10 NOA

A Diving Medical Technician 2015 Internal Anatomy Pinna NOAA Diving Medical Technic

ian 2015 The Exam 12 NOAA Diving Medical Technician 2015 The Exam 13 NOAA Diving

Medical Technician 2015 Ear Wax is Your Friend!Waxy sebaceous secretions + skin cel

lsAntipseudomonal due to acidic PHMoisture repelling waxy consistencyOccasionally n

eeds removal if:Impairs hearingInterferes with hearing aidsImpairs inspectionCerume

n “dam” causes water trapping NOAA Diving Medical Technician 2015 Low Tec

h Wax Removal 15 NOAA Diving Medical Technician 2015 Lighted Ear Curette 16 NOAA

Diving Medical Technician 2015 BIONIX 17 NOAA Diving Medical Technician 2015 Doc&#

146;s Preferred View 18 NOAA Diving Medical Technician 2015 TM Back side 19 NOAA

Diving Medical Technician 2015 Doc’s Preferred View Malleus Umbo Incus Cone of

Light Pars Flaccida Pars Tensa NOAA Diving Medical Technician 2015 Proper Techniqu

e? 21 NOAA Diving Medical Technician 2015 Technique is EverythingPosition both you

& patient for comfortHold Otoscope at balance pointUse largest possible speculum f

or comfortStraighten the external canalInspect to identify landmarksVerify optical

characteristics of TMGet a good airtight sealCheck mobility NOAA Diving Medical Tec

hnician 2015 Middle Ear DiagnosisPneumatic OtoscopyVisualize TM mobility (complianc

e)Proper use of Insufflatorrequires practiceOral or Bulb Never perform if a myringo

tomyis presentAppearance of TM Red? Bulging? Opaque? Sclerosed? Immobile?Erythemaal

one is not a reliable sign 23 NOAA Diving Medical Technician 2015 Pneumatic Otosco

py 24 NOAA Diving Medical Technician 2015 Kim’s Good Ear 25 NOAA Diving Medi

cal Technician 2015 Bony Exostosis 26 NOAA Diving Medical Technician 2015 Otitis E

xterna (O.E.)more common in swimmers/diversmost commonly bacterial90% pain (otalgia

), 10% itchpain with manipulationlymph node enlargementfoul greenishtinged discharg

eeczema, psoriasis, allergy & trauma NOAA Diving Medical Technician 2015 Bacteriolo

gy of O.E.Pseudomonas species (99%)Staphylococcus AureusStreptococcusOthersProteusE

scherichia colianaerobesAspergillusOtomycosis 28 NOAA Diving Medical Technician 20

15 Suppurative O. E. 29 NOAA Diving Medical Technician 2015 Suppurative O. E. &#

x0000;�30 NOAA Diving Medical Technician 2015 Clinical Appearance �&#

x0000;31 NOAA Diving Medical Technician 2015 Clinical Features of O.E. Pain?Aggrava

ted by chewing or manipulating PinnaTenderness?Prominent at TragusSystemic sx?Usual

ly absentLymph nodes?Often presentSwelling?External Auditory CanalOtorrhea?Malodoro

usTM?Obscured but intact��32 NOAA Diving Medical Technician 2015 Atyp

ical O.E. C/CItch and muffled hearingTenderness?AbsentSystemic sx?AbsentLymph nodes

?AbsentSwelling?AbsentOtorrhea?AbsentTM?Coated with Exudate��33 NOAA

Diving Medical Technician 2015 Atypical O.E. (?) Think “Wrong Diagnosis”

;AllergyNeomycinMastoiditisSmall perfForeign bodycottonIrritant dermatitisInappropr

iate use of chemical to prevent OEInfestationFly larva��34 NOAA Divin

g Medical Technician 2015 PreventionDr. H. Jones (1971)Boric Acid in 90% ethyl alco

hol (1924)Acetic Acid (5%) in 85% isopropyl alcohol2% Acetic Acid solution = pH of

3.05 minute contact time = bactericidal effect Vosol(glacial acetic acid 2% in prop

ylene glycol )OticDomeboro(acetic acid aluminum acetate)White Wine Vinegar = 4 to 6

% Acetic Acid��35 NOAA Diving Medical Technician 2015 Malignant Otiti

sExterna(Zebra)Occurs in diabetics, or in the immunocompromised hostHIVchemotherapy

Spreading Pseudomonas infectionSevere, unrelenting ear pain20% mortality rate�

0;�36 NOAA Diving Medical Technician 2015 TreatmentsCortisporin(10% Neomycin

allergy)(neomycin/polymyxinhczOfloxacinOticsol .3% (FloxinOticCiproHC OticClotrimz

olefor fungusAntistaphantipseudomonalparenteralfor necrotizing OE��37

NOAA Diving Medical Technician 2015 Clinical Appearance ��38 NOAA Di

ving Medical Technician 2015 Otowick ��39 NOAA Diving Medical Technic

ian 2015 ��40 &#x/MCI; 14;&#x 000;&#x/MCI; 14;&#x 000;Barotra

uma NOAA Diving Medical Technician 2015 Sea Level pressures 41 NOAA Diving Medical

Technician 2015 Descent to 2.6 fsw 42 NOAA Diving Medical Technician 2015 Descent

to 3.9 fsw 43 NOAA Diving Medical Technician 2015 Forceful Valsalva 44 NOAA Divi

ng Medical Technician 2015 Continued Descent 45 NOAA Diving Medical Technician 20

15 TEED Scale (Walter Teed, USN)Symptoms without signsErythemaalong the handle of t

he MalleusErythemaplus small splotches of hemorrhageGross hemorrhage within the TMF

ree blood in middle earPerforation NOAA Diving Medical Technician 2015 Middle Ear E

ffusion 47 NOAA Diving Medical Technician 2015 Perforation (chronic) 48 NOAA Divi

ng Medical Technician 2015 Perforation (acute) 49 NOAA Diving Medical Technician 2

015 Perforation (traumatic) 50 NOAA Diving Medical Technician 2015 Perforation (he

aled) 51 NOAA Diving Medical Technician 2015 Barotrauma? 52 NOAA Diving Medical T

echnician 2015 Barotrauma? 53 NOAA Diving Medical Technician 2015 Video Otoscopy 5

4 NOAA Diving Medical Technician 2015 Oxygen Absorption Syndrome��55

&#x/MCI; 47;&#x 000;&#x/MCI; 47;&#x 000;y&#x/MCI; 19;&#x 000;&#x/MCI;&

#xD 19;&#x 000;Positive EffectPneumothoraxVenous GasNegative EffectMiddle earsSinus