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

• 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

 

Barotrauma of the Lungs, Extra Alveolar Air Syndrome (E.A.A.S.)

• Arterial Gas Embolism (AGE)

• Tension Pneumothorax

• Pneumopericardium

• Pneumomediastinum

• Subcutaneous Emphysema

 

Extra Alveolar Air

• Physical Requirements of Diving

• Candidates

• Factors that Predispose to E.A.A.

• Primary

• Medical

• Operational

• Environmental Factors

 

Scene Management of E.A.A.

• On the Scene First Aid

• Advantages and Disadvantages of Head Down/Left Lateral Position

• The Use of Oxygen and Other Emergency Medical Procedures for Medical and Lay Personnel

 

Treatment of E.A.A.

• 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

 

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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)

• Underlying Pathophysiology of CNS Oxygen Toxicity

• Pulmonary Oxygen Toxicity

• Hypoxia

• Limits as Applied to Patients and Observers

 

Central Nervous System Oxygen Toxicity

(CNS O2 Toxicity)

• Pathophysiology 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

 

Pros and Cons of In-Water Use of Oxygen

for Therapy and Decompression

• Safety Considerations for Using Oxygen Enriched Air Mixtures for Therapy

• Oxygen Tolerance Test

• CNS Oxygen Toxicity and the Oxygen Treatment Tables

 

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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 Net Effect of a Specific Duration of Breathing Oxygen at Pressure

• Converting the UPTD to Percentage of Vital Capacity Decrement (%Vc)

 

Determining the percentage of Vital Capacity Decrement at the Dive Site O2 Consumed During the Dive During Decompression Treatment at Dive Site

• Evacuation on O2

• Amount of Oxygen Given During Treatments With or Without Extensions

• Can Oxygen Be Given on Ward After Treatment?

• When to Bring Patient Back for Retreatment

 

Signs and Symptoms of Pulmonary O2 Toxicity

 

Pathophysiology of Pulmonary O2 Toxicity

 

Arithmetic Method for Predicting Percentage of Vital Capacity Decrement

 

Pulmonary Symptom Reversal and Restart Times of the Pulmonary O2 Clock

 

Lowering the Partial Pressure of Oxygen on the Pulmonary Clock

• Open Circuit Air

• Closed Circuit Mixed Gas

• Change Gas Mixtures

 

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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

• Primary

• Medical

• Operational

• Environmental

 

Clinical Manifestations and Diagnosis of DCS

 

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.

 

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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

 

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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)

 

(Recompression Chamber 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

• Multi, Dual and Mono Chambers

• Hoods, Masks and Ventilators

• (ACFM vs. SCFM)

 

Ventilation of Respiratory Dead Space

• How the Mechanical Dead Space or Mechanical Resistance to Breathing Can Contribute to CNS O2 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: CO2 scrubbers, scrubbing agents and closed circuit systems will be discussed during special advanced programs.

 

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Nitrox Therapy Gas Mixtures (N2/O2)

 

(Recompression Manual page 79-86)

 

Why Diving Accident Victims May Require Nitrox

• The Advantages of N2/O2 for Therapy

• The Advantages of N2/O2 for Observers

 

Nitrox Mixtures

 

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

 

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Nitrox (N2/O2 )vs. Heliox (He/O2)

 

Isobaric Bubble Growth

 

Isobaric Gas Switching Resulting in Super Saturation and Life Threatening Symptoms

 

Switching to He/O2 While Increasing or Decreasing Pressure

 

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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 93)

 

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 O2 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

 

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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

 

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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

 

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Critical Care and Medical Equipment in the Hyperbaric Environment

 

(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

• Awareness

• Treatment

• Stabilization

 

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

 

Note: Daily hands on use of this equipment and procedures

 

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Recompression Chamber Safety

 

Pre-Screening Medical Equipment for Hyperbaric Environment

 

Chamber Life Support Systems

 

Preventing Chamber Fires

• fO2 >.23

• Electronics

• Types and Causes of Previous Chamber Fires

• Oxygen Safety, Handling and Analyzation

Types of Cleaning Materials, Clothing and Painting for Interior Chamber Safety

 

Pressure Vessel Integrity

• Viewports

• Piping

• Filters

 

Emergency Breathing Gases and Their Importance

 

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Practical Use of Multi-Place, Multi-Lock Hyperbaric Chambers

 

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)

• Safety Awareness

• Safety Systems

• Fire Suppression

• Compressors

• All Gas Supply Requirements

• Decompression Schedules

• Treatment Schedules