First Aid Scenario 2

[divemed06]

Ok...since some of you enjoyed the last one, here's a new one. You've decided take a trip to the Caribbean for a 1 week dive retreat. You've decided to go to one of the remote dive destinations to "get away from it all" and you hate those crouded resorts! Before leaving for your trip, you've called the dive shop to make sure that the boat you've chartered and the staff are "good to go". You make sure that your instructor is highly qualified, the boat is properly maintained and that they have a First Aid Kit, Oxygen etc.. (a prudent thing to do). The owner of the dive shop assures you that they are an excellent operator and that they even have an AED on board. Convinced, you go on your trip as planed. The diving is great....the staff are terrific and the weather is lovely. On the third day of your vacation, the weather turns a little sour. The group (8 divers), along with DM and the boat captain decide to go out for the dive but to keep an eye out on the weather. Your going to do a 30 min dive at 60 feet. You're a good 30 min from shore and the captain sets the anchor. At this point waves are at about 1 foot but nothing to serious for this experienced group of divers. After only about 5 minutes into the dive, your DM signals everyone to surface. Confused, but concerned, you and your buddy ascend with the group. At the surface the DM tells you that he thinks he has bad air and that he's not feeling well. By this time, the waves have pickup and are at about 3 feet. The DM tells everyone to get back onto the boat because they have a very strict "no guide, no dive" policy...and he's simply not feeling well. The captain starts helping everyone out of the water. As he proceeds to help one of the divers out, a big wave hits the boat and the diver falls on top of the captain smacking the captain chest first with the tank. The captain falls down in agony and is having trouble breathing. The diver who fell, smacked his head on the deck but is still concsious and alert. The DM is throwing up on the side of the boat. What do you do now? What are you're priorities (keep in mind that you have the captain, the diver and the DM to take care of)? No one else on the boat has first aid training, only you. The weather is looking bad and you're not exactly sure of where you are. The captain's breathing is getting shallower and he's really struggling he eventually goes unconscious. Do your priorities change?What are you thinking of?

Have fun!

 

[Scubamedicjoe]

First you call for help via radio second if was me i prombly think the captian has a flail chect or worse a colasp lung , he needs oxygen place him on his side with the bad lung towards the deck of boat , need needs help if have way help dive master to floor of boat oxygen as needed and acess him more look for other sign's sysmptoms , if other diver not hurt watch him and keep eyye on him someone hast to un hook anchor need to make radio contact with someone most dive boats hasve loran , GPS ect so with any common since you should be able to at least tell them that , again hard promblem but this one little bit more manageable with some medical training and hopefully boating skills lol. this is the basics part of there training with out doingmore evasive care, prombly check decomepression or worst has cardiac contussion ect ect ect capt inital treatment is all you can do till definative help arrives,

 

[archman]

otherwise you're ALL screwed!

 

[raskas]

The Captain needs oxygen and to be put in recovery postion, have one of the divers monitor for breathing/pulse and keeping airway open. The DM should be checked for carbon monoxide poisoning ( cherry red lips and nails ),if hes showing signs of that, oxygen will help but only if a second unit is available. O2 priority needs to stay with the captain. The diver with the head injury will need first aid for the cut but should also be monitored for concussion and/or shock.DCS shouldnt be an issue as the dive was called at 5 min, but it is day 3 so depends on previous dives.
Obviously the coastguard will be called first off by one of the other divers, get them to explain the situation and ask the coastguard what they need to know (location etc) ,at 30min from shore its probably gonna be a helicopter coming out you at the dive site.

 

[pismodiver]

Airway, Breathing, Circulation.

The only one in real trouble is the Captain. Someone else needs to get on the radio pronto, while you attend to him. If the Captain is still breathing spontaineously, put him on O2. If not, ventilate him with a mask. Is he difficult to ventilate? Look for evidence of rib fracture. Put your ear to each side of his chest and listen for breath sounds. Palpate the chest for subcutaneous air ("rice crispies"). If breath sounds are absent on one side, and the patient is hard to ventilate, he may have a tension pneumothorax. If you have training (or brass cojones), insert a large bore needle below the middle of the collar bone into the lung and listen for the release of air and improvement of ventilation. Of course, if at any time he goes pulseless, start cardiac compressions. Hopefully by this time, help has arrived, the DM has stopped horking his breakfast, and the diver with the head conk is complaining only of a mild headache.

Then check your own pulse. :-}

 

[GoBlue!]

Put your ear to each side of his chest and listen for breath sounds. Palpate the chest for subcutaneous air ("rice crispies"). If breath sounds are absent on one side, and the patient is hard to ventilate, he may have a tension pneumothorax.

Just a little clinical pearl, certainly subcutaneous emphysema & decreased breath sounds suggest pneumothorax, but even better for detecting small pneumothoraces (of which this likely would NOT be) is to check for tactile fremitus. Lay the side of your hand (pinky down the palm) on the chest wall & ask the person to moan, say something, etc. The side of the pneumothorax will not vibrate nearly as much. With this technique you can pick up much smaller pneumothoraces than with auscultation (especially on a noisy dive boat!).

Also, in this case, if suspecting tension pneumo, just look for deviation of the trachea to the opposite side of the chest as the pneumothorax. If I saw this, it wouldn't take brass cojones to spear the chest; I'd do it in a heartbeat.

Jim

 

[Snowbear]

Another diver can be sent to radio for help. Hand the DM a bucket and have him assist with this. If he's able - hand him a bucket and have him drive the boat home.

The diver with the lump on his head doesn't sound like he has life-threatening injuries. He can be assisted by another diver. Most any calm lay person can be instructed to maintain manual spine immobilization and talk to the patient.

The capt needs help the most. He bought himself a tube in your last sentence, but again, I need more of a physical exam before I treat him further. I would not spike his chest without s/s of a tension pneumothorax.

 

[jonnythan]

Like the other guys said, the captain is the priority. I'd probably put the DM on O2, then check abc's on the captain. The other diver should be quickly checked for alertness, and if he's ok he's going to sit down and be quiet for a bit.

Have someone get on the radio, have someone else start driving the boat back into shore. If the captain is having real trouble breathing, and it sounds like he might, I'd give him the O2 instead since his need is more urgent... but I'd like both of them on if possible. Hightail it back to shore while tending to the captain and doing what's possible to stabilize him.