Atmosph 760 mmHg Deep into sea at every 33 feet pressure rises by 1 atmosphere Vol of air compressed amp pressure increased along with depth Deep sea diver breath high pressure air PATHOPHYSIOLOGY ID: 1000271
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1. Deep Sea Diving
2. Deep Sea Diving & Hyperbaric ConditionAtmosph = 760 mmHgDeep into sea, at every 33 feet pressure rises by 1 atmosphere Vol. of air compressed & pressure increased along with depthDeep sea diver – breath high pressure air
3. PATHOPHYSIOLOGYPARAMETERDEEP SEA DIVINGHIGH ALTITUDE Barometric Pressure Volume of Gases Intra-thoracic Pressure Intra-alveolar Pressure [Compression] [Expansion]
4. Pressure Related Problems(direct)Descent (squeezes)EarsSinusesMaskThoracicTeethStomach/IntestinesSuitAscent (expansion)Air embolismPneumothoraxMediastinal EmphysemaSubcutaneous Emphysema
5. Pressure Related Problems(indirect)Decompression sicknessNitrogen partial pressuresSolubilityNitrogen narcosisOxygen toxicity
6. Partial Pressure(Dalton’s Law)760 mm Hg 47 --- mm/Hg 95 ---190 ---380 ---523 ---760 ---21%O278% N21% Other
7. Nitrogen Narcosis at High Nitrogen PressureAbout 4/5th of air – nitrogenAt sea level no ill effect of nitrogen but at high pressure (deep in sea) varying degree of narcosisFirst symptom of narcosis joviality, at 120 feet deep, after remaining for some timeAt 150 – 200 feet – Drowsy At 200 – 250 feet – Strength wanes,Beyond 250 feet – person can’t move
8. Nitrogen narcosis like alcohol intoxication -- impaired memory, impaired thought making Nitrogen mech. Same as that of gas anaesthesia
9. Nitrogen narcosisNitrogen Narcosis“Rapture of the Deep” - “Martini’s Law”SURFACE75-100m250-325 ft150-175m500-575 ft200m+Thinking andJudgmentPOTENTIALLY AffectedCommunication,Motor and MentalTasks IMPAIREDNOT IN CONTROLSymptoms and Effects onIndividual Diver VaryWith Depth and Exposure.
10. Nitrogen 5 time move soluble in fat than in waterAt sea level 1 L of nitrogen dissolved in entire body, half in body fluids & half in fat ( though fat constitutes 15% of total body)At 33 feet deep – 2 L of nitrogen get dissolved in bodyAt 100 feet deep 4 L of nitrogen Nitrogen can not be metabolized in body Diver ascends slowly to sea level In case of rapid ascent → decompression sickness
11. Decompression SicknessDecompression sickness (DCS, aka “the bends”) is the result of inadequate decompression following exposure to increased pressure
12. Decompression SicknessIf the diver ascends to quickly, the nitrogen absorbed by the diver’s body during a dive can come out of solution and form bubbles in the body’s fluids and tissues
13. Decompression SicknessIt has been common to describe decompression sickness as one of three Types, or to categorize it by the area of involvement and the severity of symptoms
14. Decompression SicknessType I includes skin itching or marbling; brief, mild pain called “niggles,” which resolve typically within ten minutes; joint pain; lymphatic swelling, and sometimes included extreme fatigue
15. Decompression SicknessType II DCS is considered to be respiratory symptoms, hypovolemic shock, cardiopulmonary problems, and central or peripheral nervous system involvement
16. Decompression SicknessType III includes arterial gas embolism and is also called decompression illness (DCI)
17. FACTORS INFLUENCING DCSExertionPhysical fitnessTemperature – cold water, hot showerSex – femalesAgeObesityDehydration Increased carbon dioxide pressuresAlcohol intakePhysical injuryAdaptationDive profileRapid and multiple ascentsRepetitive and multi-day divingAltitude exposure
18. Decompression SicknessAlso called bends, compressed air sickness, caisson disease, divers paralysis, dysbarism During rapid ascent, sufficient amount of nitrogen bubbles develop in body fluids either extra or intra cellularly Depending upon the no & size of nitrogen bubble, any area of the body can get damageBubble formation in brain vessels → paralysis; Around nerves → paraesthesia itching, severe pain; Around joints → severe pain in joints (called bends); In pulmonary vessels → Dyspnoea & chokes, coronary arteries → cardiac damage
19. Decompression SicknessLimb BendsCentral Nervous System (CNS) DCSCerebral Decompression SicknessPulmonary DCSSkin BendsInner-Ear Decompression SicknessCategorizing DCS by area involved and severity of symptom includes:
20. Decompression SicknessLimb Bends – Dull, throbbing, deep pain in the joint or tissue; usually in the elbow, shoulder, hip, or kneePain onset is usually gradual and slowly intensifiesIn severe cases limb strength can be affectedIn divers, upper limbs are affected about three times as often as lower limbs
21. Decompression SicknessCentral Nervous System (CNS) DCS – May cause muscular weakness, numbness, “pins and needles,” paralysis, loss of sensation, loss of sphincter control, and, in extreme cases, death
22. Decompression SicknessCerebral Decompression Sickness – May produce almost any symptom: headache, visual disturbance, dizziness, tunnel vision, tinnitus, partial deafness, confusion, disorientation, emotional or psychotic symptoms, paralysis, and unconsciousness
23. Decompression SicknessPulmonary DCS – aka the Chokes accounts for about 2% of DCS casesSymptoms include: pain under the breastbone on inhalation, coughing that can become paroxysmal, and severe respiratory distress that can result in death
24. Decompression SicknessSkin Bends – Come in two forms: harmless simple itchy skin after hyperbaric chamber exposure, or rashy marbling on the torso that may warn of serious DCS
25. Decompression SicknessInner-Ear Decompression Sickness – aka Vestibular DCS or Ear BendsSigns and symptoms include vertigo, tinnitus, nausea, or vomiting
26. O2 Toxicity at High PressureIf PO2 ↑ more than 100 mmHg → Dissolution of O2 in blood ↑ alsoIf someone exposed to 4 atmosphere pressure (3040 mmHg) → seizures followed by coma within 30-60 minutes Seizures may appear without warning but prove lethal other symptoms – nausea, muscle twitching, dizziness, disturbance of vision, irritability disorientation ↑ ROS production, being lipid soluble damage the cell membrane esp; nervous tissue (as with high lipid content)
27. TREATMENT OF DECOMPRESSION SICKNESS INVOLVES IMMEDIATE RECOMPRESSION, FOLLOWED BY GRADUAL DECOMPRESSION
28. LOCALIZED PAIN IN OR AROUND A JOINT MAY SOMETIMES BE RELIEVED BY APPLICATION OF LOCAL PRESSURE, e.g FROM AN INFLATED SPHYGMOMANOMETER CUFF
29. PREVENTIONGRADED ASCENTUSE OF SCUBAUSE OF HELIUM
30. TREATMENTHYPERBARIC OXYGEN THERAPY [RECOMPRESSION THERAPY]SUPPORTIVE THERAPY
31. Effects of Heat and ColdHeat injuries (hyperthermia)crampsexhaustionstrokeCold injuries (hypothermia)Decreased body functionsDecreased mental functionsShivering, numbnessRelated protection requirements
32. Temperature InjuriesTemperature InjuriesProgressive Symptoms and EffectsHeat Cold- Cramps- Exhaustion- Stroke Profuse Sweating Weakness Malaise Dry, Flushed Skin Cool Victim Oral Fluids No Caffeine/AlcoholSymptoms- Hypothermia Uncontrolled Shivering Loss of Coord/Dexterity Numbness Warm Victim No Caffeine No AlcoholSymptoms1st Aid1st Aid
33. BarotraumaDirect PressureRelated ProblemsIndirect PressureRelated Problems- Descent (Compression) SqueezesEar, Sinus, Lung,Stomach, Intestinal,Tooth, Equipment- Ascent (Expansion)Lung Ruptures -Subcutaneous andMediastinal EmphysemaPneumothoraxAir Embolism- Decompression Sickness (The Bends) (DCS)- Nitrogen Narcosis- Oxygen ToxicityDescend and AscendSlowly to MinimizePotential ProblemsNEVER HOLD YOURBREATH ON SCUBA!Precautionary Decompression Stops(Safety Stops) HelpReduce Bubble Formationand Incidence of DCS
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35. One or more tanks of compressed air or some other breathing mixture, A first-stage "reducing" valve for reducing the very high pressure from the tanks to a low pressure levelA combination inhalation "demand" valve and exhalation valve that allows air to be pulled into the lungs with slight negative pressure of breathing and then to be exhaled into the sea at a pressure level slightly positive to the surrounding water pressure, A mask and tube system with small "dead space."