Proper Position for Emergency Care

I am currently enrolled in an Emergency Medical Technician (EMT) class and my text for prehospital care of an injured diver recommends keeping the patient in a left lateral Trendelenburg position if possible. As a DAN Oxygen provider, and a diver trained to the level of Rescue, I was under the impression that the left lateral recumbent and/or the Trendelenburg position were no longer advisable. What do you recommend?
The consensus on the ideal posture for an injured diver has changed over the years and, unfortunately, many training materials for emergency medical technicians do not reflect these trends.

The following observations challenge the advice to place an injured diver in the Trendelenburg position:
  • It is often difficult to distinguish Cerebral Arterial Gas Embolism (CAGE) from cerebral Decompression Sickness (DCS);
  • Significant Arterial Gas Embolism (AGE) probably occurs in DCS by arterialization of venous bubbles. A head-down position increases venous return;
  • In the smaller vessels, bubbles trapped in circulation will travel with blood flow without regard to posture;
  • A prolonged head-down position increases cephalic venous volumes and compromises subsequent middle ear equalization, necessary in recompression therapy;
  • The Trendelenburg position limits resuscitation;
  • Studies show that the recovery of brain function is slower in those positioned head-down than those horizontal (Dutka 1990).
In summary, according to DAN’s Medical Director, Dr. Richard Moon, there may be benefit in a transient head-down posture for divers with arterial bubbles, but the balance of opinion and data favors a horizontal position. If the diver is unconscious or vomiting, or if the diver's upper airway is compromised, place them laterally recumbent, either left or right, so that the airway can be effectively managed. Divers who are experiencing neurological symptoms of decompression illness must not be allowed to sit up until inside a recompression chamber.
Posted in

No Comments


Categories

 2018 (49)
 2016 (119)
After anaesthesia Air Quality Altitude sickness Annual renewal Apnea Arthroscopic surgery Bag valve mask Bandaids Barbell back squat Bench press Boyle's Law Boyle\'s Law Boyle\\\'s Law Boyle\\\\\\\'s Law Boyle\\\\\\\\\\\\\\\'s Law Breath hold Breath-hold Buoyancy Burnshield CGASA CO2 Camera settings Cancer Remission Cancer Cape Town Dive Festival Carbon dioxide Charles' Law Charles\' Law Charles\\\' Law Charles\\\\\\\' Law Charles\\\\\\\\\\\\\\\' Law Coastalexcursion Cold Water Cold care Cold Conservation Contaminants Corals DAN Profile DAN Researchers DAN medics DAN report DCI DCS DReams Dalton's Law Dalton\'s Law Dalton\\\'s Law Dalton\\\\\\\'s Law Dalton\\\\\\\\\\\\\\\'s Law Decompression Illness Decompression Sickness Decompression illsnes Dive Instruction Dive Instructor Dive accidents Dive health Dive medicines Dive medicine Dive safety Dive staff Diveleaders Divers Alert Diving career Diving emergencies Diving injuries Diving suspended Diving Dr Rob Schneider EAP Ear pressure Ears injuries Emergency plans Environmental impact Equipment care Exercise Eye injuries FAQ Fatigue First Aid Equipment First Aid kits Fish Fitness Francois Burman Free diving Freediver Gas laws Gastric bypass Gordon Hiles HELP Health practitioner High temperatures Hot Hypothermia Indian Ocean Inert gas Instructors International travel Irritation Kids scubadiver Labour laws Legislation Leukemis Liability Risks Maintenance Medical Q Medical questionaire Medical statement Middle ear pressure Military front press Mycobacterium marinum Nitrox Non-rebreather Mask Nosebleeds O2 providers O2 servicing OOxygen maintenance Ocean pollution Orbital implants Oronasal mask Oxygen Cylinder Oxygen Units Oxygen deicit Oxygen ears Oxygen equipment Oxygen masks Part 3 Plastic Pool Diving Radio communications Rashes Report incidents Rescue training Resume diving SABS 019 Safety Save our seas Science Scuba Injury Scuba children Scuba dive Scuba health Scubalearners Skin Bends Skin outbreak Skin rash Snorkeling Sodwana Bay Squeezes Supplemental oxygen Surgeries Surgery The truth Thermal Notions Tides Travel tips Tweezers Underwater photographer Underwater pho Valsalva manoeuvers Vasvagal Syncope White balance Winter Wreck dive Youth diver abrasion air-cushioned alert diver altitude antibiotics antiseptics bandages bent-over barbell rows breathing air checklist child clearances closed circuit scuba currents dead lift decongestants dehydration dive injuries dive medicing dive ready child diver rescue dive diving attraction doctors domestic travel dri-suits dry mucous membranes dry ear spaces electroytes emergency action plans emergency assessment equalizing exposure injuries flexible tubing health hospital humidity immersion pulmonary edema (IPE join DAN marine pathogens medical procedures medical risk assesment mucous membranes nasal steroids nasal newdivers nitrogen bubbles off-gassed operating theatre outgas pain plasters post dive preserve rebreather mask rebreathers risk areas saturation scissors scuba equipment scuba single use sinus infections strength tecnical diver thermal protection training trimix unified standards warmers water quality