WKPP - Dealing with O2 tox protocols

Drmike

some good stuff here:


gue.com/Projects/WKPP/Procedures/oxtox.htm


IV. In Water Response for Tonic/Clonic episode w/o aspiration

A. Observe the seizure activity and stay close enough to the diver to prevent buoyancy problems.
B. After the seizure has stopped, maintain the diver in a face down (prone) and horizontal position. Check pulse.
C. If at all possible, transport the diver to the appropriate trough. The diver should ascend NO MORE than 10'. Descending to a deeper trough would be preferred. Transport needs to be carried out as soon as the seizure ceases and BEFORE respiration resumes.
D. Secure the diver in the trough. Place the diver on 20/20 mix or back gas (to lower PPO2). Place the regulator in the divers mouth and purge for a few seconds. Check pulse again. This also needs to be carried out before respirations resume.
E. Notify a support diver that there has been an oxygen toxicity episode, give them the divers name, depth, and time of oxygen toxicity event; at this point the support diver should immediately inform the surface manager.
F. Watch for the divers respirations to resume. Check the pulse again. If no spontaneous respirations occur within 60 seconds initiate artificial respiration. This should be done by use of the purge valve of the regulator. Purges should last for no more than 2 seconds, with an exhalation phase of 2-3 seconds. It will be necessary to manually open the divers airway and hold it in that position. This is done simply be lifting the chin upwards.
G. Once the diver has resumed respirations, note the time and wait for the diver to regain consciousness. The diver will be confused and may be combative for several minutes following, this is normal and to be expected. During this time talk to the diver to reassure him and maintain control. Once the diver is fully conscious, he should spend 15 minutes on a mix with a lower O2 percentage before resuming decompression. Deco should be resumed at the point that the diver became toxic.
H. After the toxicity episode the diver should be attended by a safety diver for the remainder of his/her decompression. This diver may well tox again and at NO TIME should they be left alone.
I. If the diver is wearing a full face mask w/ Q.D. regs, replace the gas line into the mask w/ a mix containing a lower oxygen content. Secure the diver in the trough and wait for him to regain consciousness. Notify support diver to inform surface manager. Keep the diver on the lower mix for 15 mins before allowing them to resume deco and watch carefully.

V. In water response for Tonic/Clonic episode with aspiration.

NOTE: Preventing aspiration is of utmost importance. Diligent attention needs to be given to the divers airway. If the regulator pops out of the divers mouth IT IS IMPERATIVE that the either the divers head is out of the water or that a regulator is replaced BEFORE respirations resume. The diver must stay in a prone (face down) position while being rescued.
A. Follow above steps for non-aspiration episode. If it appears that the diver aspirates proceed as follows.
B. Inform support diver that the diver in question has aspirated, they in turn will inform surface manager.
C. As long as the divers airway never relaxed underwater, then there should only be a small amount of water in the lungs. There is nothing that we can do about this underwater. The diver will most likely cough violently after he regains consciousness, therefore he will need to be watched very closely to prevent further damage.

__________________
Cave diving is a sport
Wreck diving is a sport
Diving in general is a sport

'Rebreather diving' is not a sport
its the delusional obsession with a highly dangerous and often inappropriate piece of equipment

viscya

Good stuff. Read this years ago. It should be put in the library.

__________________
"There is nothing majestic or dignified about being left to silently rot and collapse under heaps of old fishing net forgotten and unappreciated in dark and unvisited waters." DrMike

wedivebc

Where did they come up with these protocols? Are they based on many years of experience rescuing toxing divers or did someone just figure this out on their own.
Not trying to be contrary here but I was under the belief that toxing is a very rare occurance and surviving it is even rarer. Where does the info come from?

__________________
Cheers,

Dave....

Man is the only animal burdened with the knowledge he will eventually die

Mixaddict

Mike,

I absolutely can not agree with purging a regulator in another diver's mouth whether they have aspired water or not. The chance is way too great for a Laryngospasm to occur. There are numerous examples of people drowning at the surface, let alone at depth due to small amounts of water forcefully hitting the back of the throat and causing restrictions leading to suffocation.

In fact, we had a physician drown in a diving accident in my neck of the woods last year at the surface for just such a reason.

Regards,
Randy

__________________
Randy Thornton (MixAddict)
Inspiration, Evolution,Hammerhead & Sentinel
CCR Instructor

Drmike

Looking at the article this is in response to the guy not breathing and its to be done (preferably) inside the trough (not in the water)

If the alternative is to let him die (through not breathing) Im not sure if the risk (Laryngospasm) justifies not doing it.

But Im not a MD Im just reproducing the protocols they use.

__________________
Cave diving is a sport
Wreck diving is a sport
Diving in general is a sport

'Rebreather diving' is not a sport
its the delusional obsession with a highly dangerous and often inappropriate piece of equipment

Mixaddict

I understand the dilema, however I don't believe the purging is suggested in order to stimulate the starting of breathing. If I'm not mistaken, the purging is to clear potential water from the second stage. Certainly the Laryngospasm could occur from someone inhailing water in the 2nd stage, but forcing water to hit the back of the throat is probably even more dangerous.

Just my $.02
Randy

__________________
Randy Thornton (MixAddict)
Inspiration, Evolution,Hammerhead & Sentinel
CCR Instructor

Drmike

I suspect that it is

__________________
Cave diving is a sport
Wreck diving is a sport
Diving in general is a sport

'Rebreather diving' is not a sport
its the delusional obsession with a highly dangerous and often inappropriate piece of equipment

jhaaja

Good stuff. Buyoncy should be controlle d reallý good to avoid barotrauma.

Sometimes breathing does not start on its own after the convulsion. It needs mouth-to-mouth or gas from a reg. One can also think that a convulsed person can manage a long time without breathing compared to normal not breathing case. There is so much O2 in that it is possible.

JH

silent running

Thanks for posting this Mike. Makes plenty of sense, except I don't understand how descending with the O2 tox diver would help bring them around any faster. Wouldn't the increased PPO2 from descending make things more difficult and take longer? I understand that you wouldn't want to ascend much and miss a deco obligation, but descending?-Andy

jhaaja

Descending a few feet/meter is good when the diver is convulsing. That way you can minimize the risk of barotrauma. At least that is how i interpret it.

The small rise in ppO2 does not matter anything.

JH