The Provision of Breathing Gas to Divers in Emergency Situations
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Airway Pressures and Volutrauma
Airway Pressures and Volutrauma Airway Pressures and Volutrauma: Is Measuring Tracheal Pressure Worth the Hassle? Monitoring airway pressures during mechanical ventilation is a standard of care.1 Sequential recording of airway pressures not only provides information regarding changes in pulmonary impedance but also allows safety parameters to be set. Safety parameters include high- and low-pressure alarms during positive pressure breaths and disconnect alarms. These standards are, of course, based on our experience with volume control ventilation in adults. During pressure control ventilation, monitoring airway pressures remains important, but volume monitoring and alarms are also required. Airway pressures and work of breathing are also important components of derived variables, including airway resistance, static compliance, dynamic compliance, and intrinsic positive end-expiratory pressure (auto-PEEP), measured at the bedside.2 The requisite pressures for these variables include peak inspiratory pressure, inspiratory plateau pressure, expiratory plateau pressure, and change in airway pressure within a breath. Plateau pressures should be measured at periods of zero flow during both volume control and pressure control ventilation. Change in airway pressure should be measured relative to change in volume delivery to the lung (pressure-volume loop) to elucidate work of breathing. See the related study on Page 1179. Evidence that mechanical ventilation can cause and exacerbate acute lung injury has been steadily mounting.3-5 While most of this evidence has originated from laboratory animal studies, recent clinical reports appear to support this concept.6,7 Traditionally, ventilator-induced lung injury brings to mind the clinical picture of tension pneumothorax. Barotrauma (from the root word baro, which means pressure) is typically associated with excessive airway pressures. -
Clinical Management of Severe Acute Respiratory Infections When Novel Coronavirus Is Suspected: What to Do and What Not to Do
INTERIM GUIDANCE DOCUMENT Clinical management of severe acute respiratory infections when novel coronavirus is suspected: What to do and what not to do Introduction 2 Section 1. Early recognition and management 3 Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6 Section 3. Management of septic shock 8 Section 4. Prevention of complications 9 References 10 Acknowledgements 12 Introduction The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index. html for the latest updates) has presented challenges for clinical management. Pneumonia has been the most common clinical presentation; five patients developed Acute Respira- tory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation (DIC) have also occurred. Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific preven- tion or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document aims to help clinicians with supportive management of patients who have acute respiratory failure and septic shock as a consequence of severe infection. Because other complications have been seen (renal failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other complications of severe infection and treat them according to local management guidelines. As all confirmed cases reported to date have occurred in adults, this document focuses on the care of adolescents and adults. Paediatric considerations will be added later. This document will be updated as more information becomes available and after the revised Surviving Sepsis Campaign Guidelines are published later this year (1). This document is for clinicians taking care of critically ill patients with severe acute respiratory infec- tion (SARI). -
Respiratory Therapy Pocket Reference
Pulmonary Physiology Volume Control Pressure Control Pressure Support Respiratory Therapy “AC” Assist Control; AC-VC, ~CMV (controlled mandatory Measure of static lung compliance. If in AC-VC, perform a.k.a. a.k.a. AC-PC; Assist Control Pressure Control; ~CMV-PC a.k.a PS (~BiPAP). Spontaneous: Pressure-present inspiratory pause (when there is no flow, there is no effect ventilation = all modes with RR and fixed Ti) PPlateau of Resistance; Pplat@Palv); or set Pause Time ~0.5s; RR, Pinsp, PEEP, FiO2, Flow Trigger, rise time, I:E (set Pocket Reference RR, Vt, PEEP, FiO2, Flow Trigger, Flow pattern, I:E (either Settings Pinsp, PEEP, FiO2, Flow Trigger, Rise time Target: < 30, Optimal: ~ 25 Settings directly or by inspiratory time Ti) Settings directly or via peak flow, Ti settings) Decreasing Ramp (potentially more physiologic) PIP: Total inspiratory work by vent; Reflects resistance & - Decreasing Ramp (potentially more physiologic) Card design by Respiratory care providers from: Square wave/constant vs Decreasing Ramp (potentially Flow Determined by: 1) PS level, 2) R, Rise Time ( rise time ® PPeak inspiratory compliance; Normal ~20 cmH20 (@8cc/kg and adult ETT); - Peak Flow determined by 1) Pinsp level, 2) R, 3)Ti (shorter Flow more physiologic) ¯ peak flow and 3.) pt effort Resp failure 30-40 (low VT use); Concern if >40. Flow = more flow), 4) pressure rise time (¯ Rise Time ® Peak v 0.9 Flow), 5) pt effort ( effort ® peak flow) Pplat-PEEP: tidal stress (lung injury & mortality risk). Target Determined by set RR, Vt, & Flow Pattern (i.e. for any set I:E Determined by patient effort & flow termination (“Esens” – PDriving peak flow, Square (¯ Ti) & Ramp ( Ti); Normal Ti: 1-1.5s; see below “Breath Termination”) < 15 cmH2O. -
Diving Procedures Manual
Diving Procedures Manual Emergency Contacts Flinders University Security (24hrs) (08) 8201 2880 University Diving Officer Matt Lloyd – 0414 190 051 or 8201 2534 Charlie Huveneers (S&E) – 0405 635 257 or 8201 2825 Faculty Diving Administrators John Naumann (EHL) – 0427 427 179 or 8201 5533 Associate Director, WHS 0414 190 024 WHS Unit (during office hours) 08 8201 3024 Diving Emergency Service 1800 088 200 Ambulance/Police 000 (112 on mobile) SES 132 500 UHF 1 Marine Radio VHF 16 2016 TABLE OF CONTENTS OVERVIEW ............................................................................................................................................................. 5 References .......................................................................................................................................5 Section 1 SCOPE AND Responsibilities ........................................................................................................... 6 1.1 Scope .....................................................................................................................................6 1.2 Responsibilities ......................................................................................................................6 1.2.1 Vice Chancellor ........................................................................................................6 1.2.2 Executive Deans .......................................................................................................6 1.2.3 Deans of School .......................................................................................................6 -
Near Drowning
Near Drowning McHenry Western Lake County EMS Definition • Near drowning means the person almost died from not being able to breathe under water. Near Drownings • Defined as: Survival of Victim for more than 24* following submission in a fluid medium. • Leading cause of death in children 1-4 years of age. • Second leading cause of death in children 1-14 years of age. • 85 % are caused from falls into pools or natural bodies of water. • Male/Female ratio is 4-1 Near Drowning • Submersion injury occurs when a person is submerged in water, attempts to breathe, and either aspirates water (wet) or has laryngospasm (dry). Response • If a person has been rescued from a near drowning situation, quick first aid and medical attention are extremely important. Statistics • 6,000 to 8,000 people drown each year. Most of them are within a short distance of shore. • A person who is drowning can not shout for help. • Watch for uneven swimming motions that indicate swimmer is getting tired Statistics • Children can drown in only a few inches of water. • Suspect an accident if you see someone fully clothed • If the person is a cold water drowning, you may be able to revive them. Near Drowning Risk Factor by Age 600 500 400 300 Male Female 200 100 0 0-4 yr 5-9 yr 10-14 yr 15-19 Ref: Paul A. Checchia, MD - Loma Linda University Children’s Hospital Near Drowning • “Tragically 90% of all fatal submersion incidents occur within ten yards of safety.” Robinson, Ped Emer Care; 1987 Causes • Leaving small children unattended around bath tubs and pools • Drinking -
The Future of Mechanical Ventilation: Lessons from the Present and the Past Luciano Gattinoni1*, John J
Gattinoni et al. Critical Care (2017) 21:183 DOI 10.1186/s13054-017-1750-x REVIEW Open Access The future of mechanical ventilation: lessons from the present and the past Luciano Gattinoni1*, John J. Marini2, Francesca Collino1, Giorgia Maiolo1, Francesca Rapetti1, Tommaso Tonetti1, Francesco Vasques1 and Michael Quintel1 Abstract The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall. The term ‘volutrauma’ should refer to excessive strain, while ‘barotrauma’ should refer to excessive stress. Strains exceeding 1.5, corresponding to a stress above ~20 cmH2O in humans, are severely damaging in experimental animals. Apart from high tidal volumes and high transpulmonary pressures, the respiratory rate and inspiratory flow may also play roles in the genesis of VILI. We do not know which fraction of mortality is attributable to VILI with ventilation comparable to that reported in recent clinical practice surveys (tidal volume ~7.5 ml/kg, positive end-expiratory pressure (PEEP) ~8 cmH2O, rate ~20 bpm, associated mortality ~35%). Therefore, a more complete and individually personalized understanding of ARDS lung mechanics and its interaction with the ventilator is needed to improve future care. -
Simulator Measurement of the Work of Breathing for Underwater
SIMULATOP REASUREBEMT OF THE RORK OF BRIiAPHING FOB UNDEEWATER BREATHING APPARATUS Durcan Moir fliln~ E. Sc. Mar ire Science Stockton stat^ Colfege, New Jers~y,1973 A THESIS SUBEITTED IN PARTIAL PULPILLEEBT OF THE PEQUIREHENTS FOR THE DEGREE OF MASTER OF SCIENCE (KfNES IOLOGY) in the Department of Kicesiology a GUNCAN ROIB BILNE 1977 SIBOH FRASER UNIVERSITY December, 1977 All rights reserved, This thesis may nct t>f reproduced in whole or ir part, by photocopy or cthor means, without permission of tho author. NAYE: Duncan noir flllni TITLE OF THESIS: Hespiration Simulator' Htlasur+m~n* , of the Wark of Bre3thi11y far Und2rwater Breathinq A ppara tus EXhnINING COMnITTEE: Chairman: Dr. E. W. R;inister 'DL. J. n. aorrison Senior Sup:.r visor Dr, T, W. ialv.?rt Dr. A. E. Zhaprssry Ext +rnal Examin~r Prof -.ssor SLlncn Praser IJniv~rsity - at A,,,,,.,: .....................Jet, , V7r PART lAL COPYR lGHT L lCENSE I hereby grant to Simon Fraser University the right to lend my thesis, project or extended essay (the title of which is shown below) to users of the Simon Fraser University Library, and to make partial or single copies only for such users or in response to a request from the library of any other university, or other educational institution, on its own behalf or for one of its users. I further agree that permission for multiple copying of this work for scholarly purposes may be granted by me or the Dean of Graduate Studies. It is understood that copying or publication of this work for financial gain shall not be allowed without my written permission. -
Freiberg Online Geoscience FOG Is an Electronic Journal Registered Under ISSN 1434-7512
FOG Freiberg Online Geoscience FOG is an electronic journal registered under ISSN 1434-7512 2021, VOL 58 Broder Merkel & Mandy Hoyer (Eds.) FOG special volume: Proceedings of the 6th European Conference on Scientific Diving 2021 178 pages, 25 contributions Preface We are happy to present the proceedings from the 6th European Conference on Scientific Diving (ECSD), which took place in April 2021 as virtual meeting. The first ECSD took place in Stuttgart, Germany, in 2015. The following conferences were hosted in Kristineberg, Sweden (2016), Funchal, Madeira/Portugal (2017), Orkney, Scotland/UK (2018), and Sopot, Poland (2019), respectively. The 6th ECSD was scheduled for April 2020 but has been postponed due to the Corona pandemic by one year. In total 80 people registered and about 60 participants were online on average during the two days of the meeting (April 21 and 22, 2021). 36 talks and 15 posters were presen-ted and discussed. Some authors and co-authors took advantage of the opportunity to hand in a total of 25 extended abstracts for the proceedings published in the open access journal FOG (Freiberg Online Geoscience). The contributions are categorized into: - Device development - Scientific case studies - Aspects of training scientists to work under water The order of the contributions within these three categories is more or less arbitrary. Please enjoy browsing through the proceedings and do not hesitate to follow up ideas and questions that have been raised and triggered during the meeting. Hopefully, we will meet again in person -
Parliamentary Debates (Hansard)
Monday Volume 577 17 March 2014 No. 137 HOUSE OF COMMONS OFFICIAL REPORT PARLIAMENTARY DEBATES (HANSARD) Monday 17 March 2014 £5·00 © Parliamentary Copyright House of Commons 2014 This publication may be reproduced under the terms of the Open Parliament licence, which is published at www.parliament.uk/site-information/copyright/. 533 17 MARCH 2014 534 of new contracts is even greater with over a third of all House of Commons new contracts placed with SMEs in each of the last three years. Monday 17 March 2014 Mrs Madeleine Moon (Bridgend) (Lab): Devolved Administrations and their arm’s length agencies often The House met at half-past Two o’clock have very close relationships with their SME community. What discussions is the Ministry of Defence having with the devolved Administrations to make sure defence PRAYERS contractors based outside England also have an opportunity to bid? [MR SPEAKER in the Chair] Mr Dunne: Of course defence, and therefore defence procurement, is not a devolved matter and therefore the work the Ministry of Defence does is primarily with industries right across the country. I have undertaken Oral Answers to Questions events in Scotland and I am looking forward to an event in Wales in due course later this year. DEFENCE Angus Robertson (Moray) (SNP): May I wish you a very happy St Patrick’s day, Mr Speaker, and no doubt MOD Ministers will be pleased to put on record their The Secretary of State was asked— appreciation for the increasing co-operation with the Irish defence forces? Military Procurement In a parliamentary answer on 3 October 2011 the MOD admitted that out of 6,000 SME contracts with 1. -
Diving Supervisor — Level 3 (First Learning Service Provider to Be Accredited to ISO 29990:2010 Standard)
Commercial Self Contained Underwater Breathing Apparatus (CSCUBA) Diving Supervisor — Level 3 (First Learning Service Provider to be accredited to ISO 29990:2010 Standard) Singapore Commercial Diving Competency for Inland/Inshore Course Overview This course specifies the competencies required for training and certification of diving supervisors for commercial diving operations using Commercial Self Contained Underwater Breathing Apparatus (CSCUBA). The course outlines the competency and training requirements for Level 3 diving supervisor qualification: Commercial SCUBA Diving Supervisor (No decompression; maximum depth 30m) and describes the competency requirements to train dive supervisors to safely and competently plan and supervise diving operations involving CSCUBA. This standard is prepared by the Workplace Safety & Health Council (WSHC) in consultation with the Commercial Diving Association Singapore (CDAS). It should be understood by the user of this standard that the requirements contained herein are the minimum acceptable levels. The training and assessment of commercial diver trainees is carried out in accordance with the requirements of the relevant legislations, codes of practices, technical advisories and guidelines e.g. Workplace Safety and Health Act (WSHA), Code of Practice for Diving at Work (Singapore Standards SS 511) and Technical Advisory (TA) for Inland/Inshore Commercial Diving Safety and Health. This Standard is Part 2 of the standards relevant to the training and certification of commercial divers, where the requirements of authorities and industry demand a prescribed standard of training and competence to ensure an adequate degree of safety and performance during diving operations. With this standard, it provides the authorities, training providers and trainees a summary of the minimum competencies required by CSCUBA Diving Supervisors, and details the minimum content of a training course for imparting these competencies to a trainee occupational dive supervisor. -
The Pathophysiology of 'Happy' Hypoxemia in COVID-19
Dhont et al. Respiratory Research (2020) 21:198 https://doi.org/10.1186/s12931-020-01462-5 REVIEW Open Access The pathophysiology of ‘happy’ hypoxemia in COVID-19 Sebastiaan Dhont1* , Eric Derom1,2, Eva Van Braeckel1,2, Pieter Depuydt1,3 and Bart N. Lambrecht1,2,4 Abstract The novel coronavirus disease 2019 (COVID-19) pandemic is a global crisis, challenging healthcare systems worldwide. Many patients present with a remarkable disconnect in rest between profound hypoxemia yet without proportional signs of respiratory distress (i.e. happy hypoxemia) and rapid deterioration can occur. This particular clinical presentation in COVID-19 patients contrasts with the experience of physicians usually treating critically ill patients in respiratory failure and ensuring timely referral to the intensive care unit can, therefore, be challenging. A thorough understanding of the pathophysiological determinants of respiratory drive and hypoxemia may promote a more complete comprehension of a patient’sclinical presentation and management. Preserved oxygen saturation despite low partial pressure of oxygen in arterial blood samples occur, due to leftward shift of the oxyhemoglobin dissociation curve induced by hypoxemia-driven hyperventilation as well as possible direct viral interactions with hemoglobin. Ventilation-perfusion mismatch, ranging from shunts to alveolar dead space ventilation, is the central hallmark and offers various therapeutic targets. Keywords: COVID-19, SARS-CoV-2, Respiratory failure, Hypoxemia, Dyspnea, Gas exchange Take home message COVID-19, little is known about its impact on lung This review describes the pathophysiological abnormal- pathophysiology. COVID-19 has a wide spectrum of ities in COVID-19 that might explain the disconnect be- clinical severity, data classifies cases as mild (81%), se- tween the severity of hypoxemia and the relatively mild vere (14%), or critical (5%) [1–3]. -
European Diving Technology Committee COMPETENCE
European Diving Technology Committee EDTC COMPETENCE STANDARDS for PHYSICIANS of OCCUPATIONAL DIVING and TUNNELLING COMPANIES January 2019 EDTC DMA Competence Standards Document Preparation This document was prepared following consultation among the members of EDTC and detailed discussion in the EDTC Medical Subcommittee. Final approval of the document was given by the EDTC members in January, 2019 www.edtc.org EDTC DMA Competence Standards CONTENTS 1 Introduction .......................................................................................................................... 4 2 Scope ................................................................................................................................... 7 3 Requirements for Training and Assessment Establishments .......................................... 8 3.1 Courses .................................................................................................................. 8 3.2 Practice .................................................................................................................. 8 3.3 Final assessment of training for DMA (examination) .......................................... 9 4 Detailed Competence Standards ....................................................................................... 10 4.1 Level 1 - Medical examiner of divers (MED) ................................................. …10 4.2 Level 2 - Diving medical advisor (DMA) for working divers and compressed air workers ......................................................................................