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<font color='#FF0000'>How important is the admin. of fluids in a suspected dci/air embolism case ie. should it be given even with the chance of an operation being needed bearing in mind the diver is genarally only trained to first aid level and would not know accuratley the difference between dci/ air embolism
 

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Not an expert but - if you're not trained to administer IV fluids, then don't administer IV fluids. If you are then you should probly know when to administer and when not to?
 

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Not as tall in real life
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Actually are we talking IV here?

Or just administering fluids by mouth for hydration?

Does not seem too clear to me.

Daz
 

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<font color='#0000FF'>
[b said:
Quote[/b] ]if you're not trained to administer IV fluids, then don't administer IV fluids. If you are then you should probly know when to administer and when not to?
Yup.

AFAIK there is no operation available for an air embolus (but then I am not a neurosurgeon).

DDRC cards that I have seen on boats advise giving 1L of fluid iv if available or by mouth if the casualty is conscious, and no-one is qualified to administer iv.  I guess that they are the experts, so they are the people to contact if you have any concerns.

HTH
Fee
 

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At a recent O2 admin course I attended, the advice was to administer water or isotonic drinks in the case of suspected DCI.

dan.
 

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Normal treatment is to I/V up tp 2 litres of fluid fairly rapidly,(don't try this at home  
). Anyone diving should reduce risk of dehydration (dehydration = increased risk  of DCI). Casualty situation - give fluids. Not alchohol, warm not hot drinks. Orange juice, isotonics, dioralyte type are good.
 

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I was taught (and teach) to give fluids (up to one litre per hour, small sips only) to suspected DCI casualties except when there is evidence of barotrauma (burst lung) as indicated by severe chest pain and/or blood in sputum (saliva and mucous), because in this event surgery will be required to treat the barotrauma before recompression therapy can commence and administration of fluids would delay surgery
 

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For suspected DCI give fluid by mouth and continue to do so as Steve as suggested above - STOP if the casualty is not passing water as they take in more and more fluid.

Thats what I was taught anyway.
 

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<font color='#0000FF'>
[b said:
Quote[/b] ]in this event surgery will be required to treat the barotrauma before recompression therapy can commence and administration of fluids would delay surgery
Even if the casualty had a stomach full of food, they would get surgery without delay if it was an emergency, surely? Bigger aspiration risk, yes, but better that risk than waiting for the digestive tract to get a move on. In the case of fluids, can't remember how long it takes for absorption, but I'm fairly sure that by the time the diver got to the 'knock-out' room that it would no longer be a big issue. This, of course, does not apply to IV fluids.

Dehydration, however, WILL make DCI worse. Sometimes the dehydration itself is life threatening - we have seen this happen before. Also, not only does dehydration worsen DCI, the DCI worsens the dehydration. Round and round and round...
 

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<font color='#0000FF'>Well when I see someone with a pneumothorax (burst lung) I just stick a chest drain in
No surgery required unless they have a bronchopleural fistula, which you won't know until after the chest drain is in anyway.
I'm not a hyperbaric medicine doctor, but I cant see how having a chest drain in would prevent recompression - as the air in the pleural space expands it bubbles out of the drain.  Of course if any of our hyperbaric chamber operatives know different, I will stand corrected.
Fee
 

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Fee, we wouldn't dream of chambering a pneumothorax unless there were distinct neurologicals. If there were - yeh, you're right, chest drain minor problem.
 

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[b said:
Quote[/b] (Hyperbaric @ Feb. 27 2004,15:38)]
[b said:
Quote[/b] ]in this event surgery will be required to treat the barotrauma before recompression therapy can commence and administration of fluids would delay surgery
Even if the casualty had a stomach full of food, they would get surgery without delay if it was an emergency, surely?
Consider this:

You have just been out for a meal, you are on the way home when you are involved in an accident.

You are seriously injured and need urgent surgery.

Food in the stomach is not a reason to withold, we secure the airway by intubation following rapid sequence induction of anaesthesia.

Patients are kept nil by mouth if possible to reduce risks, but surgery would only be cancelled if it was non-elective.

I would echo the sentiment that fluids are most likely due to the role of dehydration in DCS and the fact that most of us tend to live in a state of perpetual dehydration.

Dom
 

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<font color='#000080'>I never realised how little i drink until we went to st abbs.  
We got there - buddy goes to the loo.  
Just before kit up - she goes to the loo.  
Dive.  
Afer de-kitt - she goes to the loo.  
Surface interval.  
Before kit up - she goes to the loo.  
Dive.  
De-kitt - she goes to the loo.  

I hadnt been ONCE! Now i know i have a bladder the size of the hindenburg, but surely i mustnt have been drinking enough?  I didnt feel thirsty, and if i force myself to drink i feel sick (and im sure the chunky bits of puke would never fit between the holes on the exhaust guards on my regs).  So how much water/juice do you drink to keep yourself safe?
 

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3 litres/day IIRC. I think we had a similar chat over at handbag recently, and can't remember what the reply to my post was then.

The above figure does not take diving into consideration, it's for a 'normal' day.

Adrian
 

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Janos' post hits the nail on the head.

If your wee is clear - you're in the clear.


Dom
 
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