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The ABBREVIATED MENTAL TEST SCORE (AMTS) can be used to assess mild delirium, confusion and other cognitive impairment. The following questions are put to the patient. Each question correctly answered scores one point. A score of 6 or less indicates impairment of brain function. A score above 6 does NOT mean that there is no cognitive impairment Question What is your age (1 point) What is the time to the nearest hour (1 point) Give the patient an address, and ask him or her to repeat it at the end of the test. (1 point) e.g. 36 Smithsonian Street What is the year (1 point) What is the name of the hospital or number of the residence where the patient is situated ( point) Can the patient recognise two persons (the doctor, nurse, home help, etc.) (1 point) What is your date of birth (day and month sufficient) (1 point) In what year did World War 1 begin (1 point) (other well known dates can be used, with a preference <strong>for</strong> dates some time in the past.) Name the present monarch/prime minister/president. (1 point) (Alternatively, the question "When did you come to [this country] " has been suggested) Count backwards from 20 down to 1. (1 point) As well as a “spot check”, this test can be used to indicate improvement or deterioration, if repeated. It is not as comprehensive as others, which may be employed by paramedics and doctors e.g. the Mini-Mental State Examination, or the TYM. Chapter 15 — 8
Chapter 16 All chapters, full text, free download, available at http://www.divingmedicine.info DECOMPRESSION SICKNESS TREATMENT FIRST AID ! Expert advice. Expert advice from a diving physician, a diving medical organisation (such as DAN) or a hyperbaric facility, should be sought as soon as possible. Appendices B and D contain a list of sources <strong>for</strong> such expert advice. In the interim, first aid treatment must be applied The principles of first aid management of decompression sickness (DCS) are: • basic life support (BLS) (see Chapter 42). • 100% oxygen (O 2 ) (see Chapter 40). • positioning and rest • fluid replacement ! Oxygen therapy If the diver breathes 100% oxygen (O 2 ), nitrogen (N 2 ) is removed from the lungs. The breathing apparatus must supply to the lungs as close to 100% O 2 as possible. This means an anaesthetic type mask or an O 2 diving regulator as used in technical and commercial diving. It is not the simple plastic hospital oxygen mask that does not produce an air tight seal. 100% O 2 in the lungs results in a high diffusion (pressure gradient) of N 2 from the blood to the lungs, causing the increased elimination of N 2 from the blood and tissues – and also from any bubbles there. Chapter 16 — 1
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Diving Medicine for Scuba Divers 4t
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ACKNOWLEDGMENTS ! For the 1 st and
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Chapter 1 All chapters, full text,
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The development of self-contained a
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Water is much denser than air and 1
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This law can easily be demonstrated
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For example, if diver has a maximum
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Stated in another way; if a gas is
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Henry's Law This law describes the
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O 2 supports combustion vigorously
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BUOYANCY It is important for divers
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the water temperature decreases wit
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Below the larynx the air passes thr
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Gas Uptake and Loss Air, which cont
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In venous blood, the haemoglobin in
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Circulation The blood flow from the
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educes the safety margin in the eve
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infections, hypothermia, panic and
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BREAK POINT Fig 4.2 . . This diagra
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MEDICAL CHECKLIST FOR SNORKELLERS H
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Some face masks are fitted with a o
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Snorkel The snorkel allows the dive
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A poorly fitting wet suit can cause
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entanglement with other equipment i
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1. Air supply, cylinder, tank 2. On
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Difficulties are still encountered
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STANDARD DRESS or HARD HAT This tra
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Closed and Semi-closed Circuit REBR
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the B.C. to be inflated using air f
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The scuba tank may be negatively bu
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Diving Watch A reliable, accurate,
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Surface detection aids include: •
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The "Half Tank Rule". The best tech
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It is important to return to the su
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The problems centre on impaired vis
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The lower surface pressure also mea
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In general, successful military div
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Factors which upset a diver's emoti
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The above story illustrates some of
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Women divers must be doing somethin
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convenience, most women today prefe
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Other Diving Diseases In a number o
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! Decompression sickness. As mentio
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vibrate. These vibrations are trans
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Fig. 9.5 If equalisation does not o
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If the ear drum was perforated, com
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The diver should then equalise ever
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If reasonable, avoid the use of hoo
Page 104 and 105: One or more of these must be presen
Page 106 and 107: There are four main groups of sinus
Page 108 and 109: TREATMENT Any case of suspected sin
Page 110 and 111: Chapter 11 All chapters, full text,
Page 112 and 113: Fig. 11.2 The various clinical mani
Page 114 and 115: Fig 11.3 The location of the medias
Page 116 and 117: Occasionally a valve effect allows
Page 118 and 119: The air bubbles obstruct or damage
Page 120 and 121: Predisposing Factors ! Breath-holdi
Page 122 and 123: In many navies free ascent training
Page 124 and 125: ! Out of Air (OOA) and Low on Air (
Page 126 and 127: PULMONARY BAROTRAUMA OF DESCENT (LU
Page 128 and 129: This condition is easily prevented
Page 130 and 131: SUIT BAROTRAUMA OF ASCENT ("BLOW UP
Page 134 and 135: SATURATION When tissues are subject
Page 136 and 137: DIVE PROFILES The type of dive has
Page 138 and 139: ! Cold. Diving in cold conditions m
Page 140 and 141: A very short surface interval may a
Page 142 and 143: ased on modified Haldane principles
Page 144 and 145: DECOMPRESSION METERS and COMPUTERS
Page 146 and 147: ! Safety suggestions (the DC Ten Co
Page 148 and 149: ONSET OF SYMPTOMS The clinical feat
Page 150 and 151: confined within the solid bone of t
Page 152 and 153: SKIN MANIFESTATIONS of DCS These ar
Page 156 and 157: Unfortunately 100% O 2 can be toxic
Page 158 and 159: Transportation in aircraft presents
Page 160 and 161: Other tables are available which in
Page 162 and 163: ! Slow ascent rates. A slow ascent
Page 164 and 165: epeated minor trauma which is commo
Page 166 and 167: Prevention Avoidance of the known p
Page 168 and 169: CAUSES OF NITROGEN NARCOSIS The exa
Page 170 and 171: A diver who can "hold his liquor" i
Page 172 and 173: CLINICAL FEATURES The first sign is
Page 174 and 175: obstruction somewhere in the respir
Page 176 and 177: the lungs and body into the counter
Page 180 and 181: CAUSES OF O 2 TOXICITY For resuscit
Page 182 and 183: Pulmonary Effects These effects wil
Page 184 and 185: Clinical Features A person hyperven
Page 186 and 187: CO 2 toxicity may increase the like
Page 188 and 189: CLINICAL FEATURES Symptoms are thos
Page 192 and 193: If the compressor is operated in an
Page 196 and 197: eaches the surface. If the diver is
Page 198 and 199: TREATMENT Rescue and recovery from
Page 200 and 201: PREVENTION It is paradoxical that d
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Fig. 27.3 Graph illustrating surviv
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PREVENTION Alcohol and other drugs
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Occasionally this disorder has been
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! Treatment. All coral cuts should
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! Vibrio and other Aquatic Organism
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SWIMMING POOL GRANULOMA Also called
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Until the risk is excluded it would
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MARINE Chapter 29 All chapters, ful
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! Stop the blood loss. This must be
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The venom has its most serious effe
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IRUKANDJI SYNDROME This disorder wa
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The first aid basic life support me
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hospital as soon as possible. Serio
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The spine may produce a puncture an
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Middle Ear Disorders Disturbances o
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CAUSES OF VERTIGO Problems arising
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Nitrogen narcosis may aggravate ver
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CRAMPS Cramp is a painful spasm of
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Air emboli and bubble development i
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Cold water entering an ear canal ca
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unconsciousness have been well reco
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SEASICKNESS This is a distressing a
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EXPLOSIONS - UNDERWATER BLAST This
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In addition to these the causes ass
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COLD OR HYPOTHERMIA (SEE CHAPTERS 3
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GENERAL MEDICAL CONDITIONS A variet
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! Major Causes of Death identified
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unfortunately promoted by some inst
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Fig 34.3 But not always ! Buddy res
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Salt Water Aspiration This factor w
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Nitrogen Narcosis This was an effec
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Other Equipment Problems In 5% or l
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SUMMARY Diving fatalities generally
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CONTRIBUTING CAUSES There are a num
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This reflex is present to some exte
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! Myocarditis. Some viral infection
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Flora Fisk Quiz for Recreational Di
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(50 ft) and admitted to being "bent
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is undertaken. Then a drug reaction
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Antihistamines These are usually ta
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PROPHYLACTIC (PREVENTION) DRUGS Sta
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Marijuana — Cannabis or "pot" Chr
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Some antibiotics may have no direct
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The hearing function test (pure ton
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MEDICAL EXAMINATION FORMAT There is
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Chapter 38 — 9
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Chapter 38 — 11
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RESUSCITATION EQUIPMENT • Airways
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INFORMATION NEEDED about a DIVING A
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in medicine have 100% O 2 delivered
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compatible. Otherwise the diving il
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GENERAL INFORMATION Oxygen Toxicity
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CHECK LIST FOR DIVING ACCIDENTS INF
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D and R - DANGER and RESPONSE DANGE
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If the rescuer has the equipment an
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Duration of CPR Continue CPR until:
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THE TECHNICAL DIVE 1. DIVE PROTOCOL
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For the same depth/duration dive, t
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OXYGEN ENRICHED AIR or NITROX (EANx
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likely to oxidise and have a higher
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There is also a greater conductive
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The carbon dioxide absorbent must b
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• The oxygen rebreathers are clos
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CONCLUSION There are few problems i
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The actual incidence is unknown, bu
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Appendix A All chapters, full text,
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DIVING MEDICAL TEXTS • *Diving Me
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Appendix B All chapters, full text,
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Appendix C All chapters, full text,
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Appendix D All chapters, full text,
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