Solve the Diving First Aid Scenario!

[mogwai]

Many thanks!

JAG

Swollen tongue, siezure, unconcious. Anaphylatic Shock? Sounds close as well. In that case get him/her the hell out of Dodge and to the nearest hypo of adrenalin.

 

[Capnsnott]

This has been one of the most thought provoking threads ever. I'm taking my CPR/AED class next week and my Rescue diver class the end of the month. I've been studying my books and was able to put a lot of real world thinking into it from this thread.
I have some questions.
In the case of the swollen tongue:
1) How could a frontal fall cause damage and the tongue to swell? I need help on this one, please explain it to me.

2) How about strangulation from the dry suit?
If it was a rental, it wouldn't be cut at the throat. What if he had passed out trying to climb the hill with little to no ability to breath properly and maybe allready being winded?
I had a partner (not picked by me) who was having problems breathing in his rental, especially after the dive (when he was worn out). He also used air twice as fast as me.

3) I'm assuming that if he bit his tongue, there would be enough blood to figure this out????

4) If he hit his head and that caused the convulsing, wouldn't there be enough damage to the head to figure this out?
Is there a possibility he fell and his gear caused this (neck or spinal injury)?

I have seen a case where a guy fell forward, hit his head on an embankment and caused a neck injury.

Very cool reading, thanks again.
Greg

 

[tinman694]

Ok folks...here's a diving first aid scenario for ya...
You're out doing a nice easy shore dive with your buddy. It's gonna be a wreck dive (no penetration) at a site that you're both familiar with. It's a bit out of the way (it took you 2 hours to get there by car). There's nothing around the dive site besides the dirt road that brought you there.
What's you're next step? (You don't have a cell phone and there are no houses around...no one is around!)
In what sequence would you do things?
What is your main concern?


.... after about 4 minutes, your buddy starts convulsing.... What could be a probale cause for this? Name at least 2 things...

Have fun! :bogey:

Let him seize, wait til he is post-ict and check ABC's--If he is still breathing, go get help.
You can't do much without help-even with it (ALS Intervention) chances are he wouldn't last real long--and who goes to a remote location any more without some kinda comm gear??

 

[Snowbear]

1) How could a frontal fall cause damage and the tongue to swell? I need help on this one, please explain it to me.

The fall most likely did not cause the swollen tongue. Whatever caused the swollen tongue probably caused the fall.

2) How about strangulation from the dry suit?

His whole head would be swollen/purple, not just his tongue.

3) I'm assuming that if he bit his tongue, there would be enough blood to figure this out????

Probably

4) If he hit his head and that caused the convulsing, wouldn't there be enough damage to the head to figure this out?

Not necessarily. Sometimes swelling takes a while and a conk to the head hard enough to cause brain injury will not necessarily result in a cut to said head.

Is there a possibility he fell and his gear caused this (neck or spinal injury)?

Huh? I'm not sure what you're asking.

 

[Capnsnott]

I'll try to ask it another way.
If a person were to fall forward is it possible for the tank to impact the person hard enough to cause a head injury. Assuming their BCD was loosened some by the person.

Thanks, every bit helps.
G

 

[divemed06]

I'll try to ask it another way.
If a person were to fall forward is it possible for the tank to impact the person hard enough to cause a head injury. Assuming their BCD was loosened some by the person.

Thanks, every bit helps.
G

The short answer to your question is yes it is possible. It's important to keep in mind that there are varying degrees of head and neck injuries. There are, however, certain patterns of injury which are more common with certain mechanisms of injury. Keep in mind that the "neck" includes the spinal cord, vertebraes, discs, ligaments, blood vessels, lymphatics, surrounding muscles, conective tissue etc..That being said, the force required for certain injuries as well as the mechanism of injury(ie. a complete transection (tear) of the spinal cord requires a certain amount of force and the approprate vectors of that force) helps somewhat determine the extent of the injury. On the othe hand, simple concussions require relatively little force. Hope this helps.

 

[Dave_1985]

Unfortunately with my training, any person I come across unconscious has to be treated as a possible spinal injury... unless there were trained witnesses who saw the injury take place. Since that didn't happen, and I don't have a backboard handy, I'm not allowed to move him.

Any WFR-WEMT's around? I'm thinking you folks have different protocols in place for this situation.

If the casualty is in a life threatening position (could deteriorate while uncompanied) as this patiend clearly could, i would say you have to risk the move, even with the possibility of spinal injuries, you do what you can to imobilise the casualty, but its gotta take hind seat to making sure he gets profesional medical care asap

feel free to flame me about any inconsistancies, errors of judgement, or to sort out my priorities, we only learn through our mistakes, and having them pointed out before you make them is a lot easier

 

[Dave_1985]

The swollen tongue is a weird one. Finger sweep just to be sure... try to ventilate through nose. Gotta get the air in there somehow. At that point, the guy needs to get the **** out of there and to a hospital.

Bee sting, Wasp sting?

anaphalactic shock a possible cause for the convulsion?

 

[adder70]

Now you're thinkin'! You probably have a few other items on hand that would take much less time to modify, however... (did you bring the duct tape with you when you went down the hill to your patient?)

Just saw this thread and at this point I am wondering about all of the hoses around along with a knife to cut one to length. Sure, it's not a huge tube, but it's something. You might even be able to get it pas the tongue without any incisions, though a seizure would put you back at foreign object obstruction. (At least you would still have all of your fingers with which to complete the treatment, though!)

 

[sndt1319]

First, Why are we assuming that the guy fell? If he had a heart attack couldn't have happened why he was seated? It seems after you checked the ABC you would want to see if you could find evidence that he did fall. If he didn't, then you can move him no problem. Also if he has his BCD on wouldn't a BP protect the lower spine very well. Also IF he were in a jacket style couldn't you inflate that to keep his body from moving around? Using something else to secure the neck and his BP/BCD to secure the back wouldn't this keep the spine fairly sercure? This is obviously not ideal but it seems better than leaving the guy there for 4 hours while you get help. In the area of a spinal injury, if he had a siesure wouldn't he have already moved himself around alot during that. The only siesure I have seen the guy contorted quite a bit. So would the damage been done already if his spine was hurt? In the area of a head impact wouldn't a blow be greatly reduced by the hood if he was still wearing it? 7mm of neopreme could take a lot of the force out of a blow. I am only asking and am not even a rescue diver yet so if I am horrible wrong I won't feel bad if you blast my ideas