NAMI Recompression Chamber Supports Area Training Missions, Operations

 

A hyperbaric chamber prevents “bubbles with troubles” injuries in Navy divers.

The Naval Aerospace Medical Institute (NAMI) Hyperbaric Medicine Department team uses the NAMI Recompression Chamber on NAS Pensacola to treat pressure-related injuries. The chamber is also used in hyperbaric medicine, which can treat many additional injuries and conditions with the patient receiving oxygen or oxygen blends while in the chamber.

“Scientists figured out how to build a chamber to pressurize that person back down to a depth where those bubbles go back into solution,” Capt. Henry F. Casey III, M.D., department head, NAMI Hyperbaric Medicine Department. “It's a recompression chamber — we recompress people. It's basically a Coke can on its side, and we pump air into it to bring it down to whatever depth we need to treat the patient." Navy Medicine

Full story: https://www.dvidshub.net/.../nami-recompression-chamber...

In the Gulf Coast region, naval training missions and operations involving scuba diving are common, with many units and agencies frequently diving in the area.

Scuba diving can be extremely dangerous, and it’s possible for divers to develop adverse medical conditions and injuries while performing underwater operations. A common diving injury is decompression sickness (DCS), also referred to as the “bends.”

“Scientists figured out that the decompression sickness is caused by nitrogen bubbles coming out of solution in the bloodstream,” said Capt. Henry F. Casey III, M.D., department head, Naval Aerospace Medical Institute (NAMI) Hyperbaric Medicine Department. “If you spend time at depth, you actually onboard gases like nitrogen.”

After a diver reaches 99 feet, nitrogen becomes toxic and divers can literally become intoxicated while underwater.

Casey said many people die every year because they're basically drunk under water after 99 feet and make tragic, unwise decisions.

“So the decompression sickness problem is when people come up too fast from depth, those nitrogen bubbles come out of solution too fast and our normal scrubbing system, which is our lungs, gets overwhelmed and those nitrogen bubbles go all over the body. If you come up too fast, you're going to get bubbles — so, ‘bubbles is troubles.’”

Lt. Cmdr. Nolan Carter, the diving officer and hyperbaric nurse on the NAMI team, came up with the phrase “bubbles is troubles” to simply explain how decompression sickness develops in divers.

More than 100 years ago, divers who experienced so much pain that they couldn't stand up straight after diving were said to have the bends — a signature symptom of decompression sickness.

“You have people come up and they can't walk, and they sometimes are so bad, it looks like they have had a stroke” Casey said. “Really bad decompression sickness will kill you.”

Over the years, experts developed technology to treat the bends in scuba divers and others who experience pressure-related injuries.

“Scientists figured out how to build a chamber to pressurize that person back down to a depth where those bubbles go back into solution,” Casey said. “It's a recompression chamber — we recompress people. It's basically a Coke can on its side, and we pump air into it to bring it down to whatever depth we need to treat the patient”.

Casey said the recompression chamber treatment is essentially a dry scuba dive.

“Physiologically they're scuba diving, but they're not wet,” Casey said.

Recompression chambers in the fleet are mainly employed to treat the bends.

“The Navy decided to have these hyperbaric chambers placed where operational dives are,” Casey explained.

The NAMI Recompression Chamber on NAS Pensacola supports many units, agencies and activities in the area, including special operations commands, the Coast Guard and other units conducting diving, training and naval flight operations.

“On any given day, we're probably supporting up to 500 people doing operational training or missions,” Casey said. "So, we're on standby for that group of people.”

“Our job is to treat pressure-related injuries,” Casey said. “The pressure-related injury usually ends up being the bends, so that's what our chamber is here to do. That's what all Navy chambers around the world do — they support Navy diving and naval aviation.”

Casey said the recompression chamber can be used for naval aviators who need treatment. For example, if an aviator experiences a significant change in pressure during an altitude-related event in flight, they can develop decompression sickness and may need to utilize the NAMI recompression chamber and the experts who treat pressure-related injuries.

Hospital Corpsman 2nd Class Evan Peck, who is on the NAMI recompression chamber team, said the recompression chamber is also used in hyperbaric medicine, and can treat many additional injuries and conditions with the patient receiving oxygen or oxygen blends while in the chamber.

“Oxygen is the most important medication that we have,” Peck said. “There's some dangers to the oxygen therapy when we put (patients) under pressure. But, the Navy has been working with this for a long time. We've got a lot of good research on it, and we've been one of the leading groups in the world.”

Casey said The NAMI Recompression Chamber is the only hyperbaric chamber in the Navy accredited by the civilian Undersea and Hyperbaric Medical Society (UHMS). The medical community relies on the UHMS for guidance on the safety and effectiveness of hyperbaric oxygen therapy for specific diseases and conditions.

“The idea is to bring people down to pressure, put them on oxygen and that oxygen gets absorbed into the body,” Casey explained. “Oxygen is a very healing substance. So, the hyperbaric oxygen therapy is great for wound care as well as DCS.”

The hyperbaric medicine team here can treat air or gas embolisms, bone infections, diabetic foot wounds and even certain types of poisonings. In all, the hyperbaric chamber on NAS Pensacola can treat 14 conditions and injuries in patients.

We can treat different emergencies like carbon monoxide poisoning, Casey said.

“We can put people in the chamber and we can flood them with oxygen, and that helps move that poison out,” Casey explained. “Sometimes there's a blood clot that gets stuck in the eye and it will cause blindness,” he added. “But we can bring people here and treat that.”

Whether a Navy diver surfaces from the Gulf with the bends, or a DoD retiree needs treatment for a bone infection, the NAMI recompression chamber team is ready to support and treat patients with this extraordinary and innovative medical technology.

ESCLEROSIS MULTIPLE. Infografia by MSP

 

ESCLEROSIS MULTIPLE. Infografia by MSP 

#MSPNeurología | La esclerosis múltiple se clasifica en diversas formas de evolución dependiendo de cómo se manifiesta. La literatura médica indica que se puede identificar si está activa y si la discapacidad aumenta progresivamente con el tiempo.

Esta condición aún no cuenta con una cura, sin embargo, se pudo conocer que el virus de Epstein-Barr estaría relacionado con la aparición de la enfermedad: http://ow.ly/fABL50Hv8FP

Aprende más sobre esta patología con esta infografía o en www.medicinaysaludpublica.com

#MSP: Lo más relevante para médicos, pacientes y profesionales de la salud. #Pioneros

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Neurological assessment. Evaluación neurológica Infografia by Nurse Key

 

Evaluación neurológica

La discapacidad es una parte vital del proceso de evaluación ABCDE. Revela problemas neurológicos tanto primarios como secundarios y, por lo tanto, permite una pronta intervención terapéutica que, en muchos casos, puede salvar vidas.

Evaluación del deterioro de la conciencia

Disability is a vital part of the ABCDE assessment process. It reveals both primary and secondary neurological problems and thus enables prompt therapeutic intervention which, in many cases, can be life-saving.

Assessment of impaired consciousness

Firstly, the patient’s level of consciousness (LOC) needs to be determined. The LOC is controlled by the reticular activating system (Chapter 46) and two distinct components of LOC are thought to exist: arousal, indicating how awake an individual is, and awareness which determines cognitive function and the extent to which the patient is able to recognise and respond to the general environment. Impaired consciousness may occur for a variety of reasons, including: primary injuries to the brain secondary to trauma or vascular accident; hypoxaemia; acidosis; infective disorders; status epilepticus; hypothermia; biochemical and metabolic disturbances; drug overdose; and poisoning. For some people rapid deterioration will occur requiring equally fast and accurate assessment, in the first instance the use of the AVPU scale¹ (Table 47.1), is recommended. This will reveal whether the patient is fully alert, verbalises appropriately, responds to pain (Figure 47.1) or doesn’t respond to anything. Signs and symptoms of stroke (Chapter 48) should always be looked for, using the Face, Arm, Speech and Time (FAST) test (Figure 47.2).

Glasgow Coma Scale

The Glasgow Coma Scale (GCS)(Table 47.2) is commonly used to monitor deficits if neurological impairment is established.²

^{https://nursekey.com/neurological-assessment-2/}

10 obsolete EMT skills. By EMS1.com

prehospital spinal immobilization on backboards

10 obsolete EMT skills

Gather round to learn the out-of-date and obsolete EMT skills that the Ambulance Driver has outlasted during his EMS career

Jun 29, 2016

EMS1

Nothing makes me feel older than when I drop a casual reference to an EMT skill in a continuing education class and several bewildered young EMTs raise their hands hesitantly and ask, "Kelly, what are MAST pants?"

It got me to thinking how different the EMS profession is now from what it was when my career began. Medicine is a continually evolving process, and advances in technology come so rapidly that the current generation of EMS providers is working with a markedly different knowledge base and set of skills than the last one.

So gather around the campfire children and let Uncle Kelly tell you how we did it in the old days. Each of these 10 skills is something we used to commonly do, but are rarely, if ever, used any longer.

Pneumatic Anti-Shock Garments 

10. Pneumatic Anti-Shock Garments 
I only spell it out because if I said MAST or PASG, I’d still have to explain it to you young whippersnappers. See, back in the day we used to put these inflatable Velcro pants on shock patients, and when inflated, it raised their blood pressure. It did raise blood pressure very well — to the point that the patient bled pink from all the IV fluids we gave, but those magic pants sucked at saving lives.

Not only did we have to know the different methods of applying them, like the diaper method and the pajama method, we also had to memorize the criteria for removal. Dinosaurs, say them with me now: “Bilateral large bore IV access, two units of typed and matched blood, surgical team on standby, deflate the abdominal section for 10 seconds, recheck the blood pressure …”

MAST Pantalon Anti-Shock. Military anti-shock trousers, or pneumatic anti-shock garments (PASG) 

https://emssolutionsint.blogspot.com/2019/04/mast-pantalon-anti-shock-military-anti.html

Manual defibrillation paddles 

9. Manual defibrillation paddles 
You kids these days with your hippity-hop music and your iThings and your hands-free multifunction electrodes.… Why, in my day, when we wanted to defibrillate someone, we had these things called paddles. And you had to apply conductive gel to them and smear it around; then you had to press them on the chest with at least 25 pounds of paddle pressure

And you had your energy select dial and defib button right there on the paddles. And you did this thing called a quick look, so that you could immediately shock the patient, like, three times in a row, before you even attached the monitor leads.

And by God, we were grateful.

Esophageal Obturator Airways 

8. Esophageal Obturator Airways 
Imagine if a Combitube and a BVM had a baby, and the airway baby inherited the worst features of each. The EOA was a supraglottic airway that was bulky, often caused trauma on insertion, did a poor job of isolating the trachea and protecting against aspiration and still required that you maintain a mask seal.

And to think that nobody uses these beauties anymore! Crazy, right?

Oral screws 

7. Oral screws 
Picture — because I am afraid of what you might stumble across if you Google "oral screws" — if you will a little plastic doohickey shaped like a miniature ice cream cone with threads on the outer surface and a T-handle on the large end. And what you did was insert the small end of this doohickey between someone’s teeth when their jaws were clenched, and screwed it in until it forced their jaws apart.

We used to do this whenever someone had a seizure, in the mistaken belief that if we didn’t get their mouth open, they’d swallow their tongue.

But the real reason was that it gave paramedics with a juvenile sense of humor the opportunity to hold out their hands and bark, "Gimme an oral screw!"

I’m telling you, that one never got old.

6. Taping stuff down 
When I was a paramedic student, my instructor took great pains to show us how to tear thin little strips of adhesive tape to secure IV catheters and endotracheal tubes. We fashioned elegant little chevrons of tape over the wings on our IV catheter hubs (seriously, they had wings) to secure them without obscuring the cannulation site. And we used to tear a one-inch strip of tape longitudinally for a few inches, wrapping one strip around the endotracheal tube and the other across the face like a big mustache.

And then someone would promptly rip our IV or endotracheal tube out while we were loading the patient, so we got to do it again.

Nowadays we have tube holders and IV dressings, and taping is a lost art like calligraphy and darning your socks.

5. Rotating tourniquets 
Once upon a time, we used to think that acute pulmonary edema and decompensated congestive heart failure was caused by too much blood re-entering the lungs. We thought that if we could trap blood in the extremities, we’d reduce preload enough to relieve the pulmonary edema.

So we applied humongous blood pressure cuffs on three of the patient's four extremities, inflated them to just above diastolic pressure, and rotated them around the patient's extremities every 15 minutes.

And it took us only a generation or so to discover that it was stupid and didn’t work.

Trendelenburg position 

4. Trendelenburg position 
For many years we fervently believed the Trendelenburg position was a vital treatment for shock. We thought that elevating the feet higher than the head raised blood pressure, and maybe even caused a couple units of blood to flow from the legs to the trunk.

Turns out it doesn’t really do those things, and instead caused respiratory decompensation and a rise in intracranial pressure. Still, that doesn’t keep some EMTs working for the EMS Agency That Time Forgot from carefully applying and documenting "patient placed in Trendelenburg position."

3. Standing takedowns 
Now that our current understanding of spinal cord injury acknowledges that prehospital spinal immobilization on backboards has virtually no supporting evidence and probably does more harm than good, we’re boarding far fewer people these days.

While the adage holds true that “absence of evidence does not mean evidence of absence,” and there may be some yet-undiscovered tiny subset of patients that benefit from strapping a curved body to a flat board, it’s a pretty safe bet that subset does not include people walking around the scene under their own power.

External jugular IV access 

2. External jugular IV access 
Honestly, I really miss this one. The EJ used to be my go-to vein in a code. I was already right there at the head intubating, and all it took was turning the patient’s head to one side a bit, sinking a 14-gauge in that fat, engorged vein, and you had the mother of all peripheral IV accesses.

You know, we did this so all those questionably beneficial drugs we gave could reach the heart that much faster. Now, with mechanical IO devices like the EZ-IO in my repertoire, I can’t remember the last time I started an EJ.

Adult IO devices have really revolutionized emergency peripheral vascular access. And not a moment too soon, either, before this intracavernous technique really caught on.  

1. Radio 10 codes 
Once upon a time, we used to take sadistic pleasure in rapid fire broadcasting to the brand-new dispatcher, "Dispatch, we’re 10-98, 10-8, 10-19, 10-18 to our 10-42, where we’ll be 10-7 for a few minutes for a 10-33 10-100. If we’re not 10-2 on that, we’ll be happy to 10-9."

Now that we communicate in plain English because 10 codes are confusing and vary between agencies, we get to say, "Dispatch, we’ve completed our last assignment and are available for call, but we’re heading to our station as soon as possible because my partner will be out of service taking an emergency all-he-could-eat taco buffet poop. If you didn’t copy all that, I’m willing to repeat it."

Or at least we get to say that once.

I could think of a few more EMT skills that may soon become obsolete if we don’t get better at applying them, but that’s my list of top 10 obsolete EMT skills.

Got any to add to the list? Chime in with yours in the comments.

About the author

Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com. Kelly is a member of the EMS1 Editorial Advisory Board.

by EMSWORLD E-Book ¿Cómo las primeras técnicas y dispositivos allanaron el camino para las innovaciones modernas en la atención prehospitalaria? / How Early Techniques and Devices Paved the Way for Modern-Day Innovations in Prehospital Care PDF

E-Book ¿Cómo las primeras técnicas y dispositivos allanaron el camino para las innovaciones modernas en la atención prehospitalaria? / How Early Techniques and Devices Paved the Way for Modern-Day Innovations in Prehospital Care PDF

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We may snicker, cringe or look askance at historic photos of primitive tools used in early health care, but they often represent significant advancements in medical treatments available to patients and practitioners at the time.

This supplement, a compilation of EMS World feature articles authored by paramedic and EMS World Editorial Advisory Board Member Mike Rubin, looks back to the early techniques and devices used in prehospital medicine, and how these foundational developments paved the way for modern-day EMS care.

Fill out the fields below to download this e-book.

We may snicker, cringe or look askance at historic photos of primitive tools used in early health care, but they often represent significant advancements in medical treatments available to patients and practitioners at the time.

This supplement, a compilation of EMS World feature articles authored by paramedic and EMS World Editorial Advisory Board Member Mike Rubin, looks back to the early techniques and devices used in prehospital medicine, and how these foundational developments paved the way for modern-day EMS care.

FIBRILACIÓN AURICULAR FA. Infografia by MSP

FIBRILACIÓN AURICULAR FA. Infografia by MSP

 #MSPCardiología | La fibrilación auricular aumenta el riesgo de accidente cerebrovascular, insuficiencia cardíaca y otras complicaciones relacionadas con el corazón.

Los tratamientos para esta condición del corazón dependen de hace cuanto tiempo que tiene esta enfermedad, síntomas y la causa subyacente del problema cardíaco.

Aprende más de los tratamientos con esta infografía o en https://lnkd.in/dSunwEi

#MSP: Lo más relevante para médicos, pacientes y profesionales de la salud. #Pioneros

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ASI FUNCIONA LA SENSACION DE HAMBRE. Infografia by MSP

 ASÍ FUNCIONA LA SENSACIÓN DE HAMBRE. Infografia by MSP 

#MSPGastroenterología | El #hambre #emocional se activa por un estímulo interno o externo, el cual produce determinada emoción y este tipo de hambre puede aparecer repentinamente, incluso después de sentirnos ya saciados. Conoce más en www.medicinaysaludpublica.com 

#MSP: Lo más relevante para médicos, pacientes y profesionales de la salud. #Pioneros

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