The most remarkable thing about breathing, is just how unremarkable it is…
If you are in a quiet place listen to your own breathing, it will help you relax and you will notice that the action of breathing is almost undetectable (if you are in good health) take 10-20 gentle quiet breaths per minute with no effort required.
When a guest or crew member has breathing difficulties, the airway and lungs can become noisy and require a lot of effort from the chest muscles to help get air and oxygen into the body. The breathing rate (10-20 breaths per minute) can become too fast or slow, and the oxygen level can be low (below 94%) or normal (above 94%). A common position someone will adopt when struggling to breath is a tripod, hands leant on the knees to open the space around the lungs.
The cause of breathing difficulties can range from a dive issue, a medical condition such as asthma, or emergency such as anaphylaxis, sepsis (whole body infection), a bleed or damage to the lungs. Whatever the cause, if a person is not taking approximately 10-20 breaths per minute (respiratory rate), and/or has an oxygen level below 94%, or they are just looking very unwell – pale, clammy and blue around the edges, we need to act, and act quickly.
Within minutes of a low oxygen state the tissues of the vital organs will begin to malfunction and die, and this could eventually lead to a seizure, coma and the heart stopping. An oxygen kit is required and should be transported as a priority to any medical incident, alongside the defibrillator and grab bag. The content of the kit should be familiar to all crew from annual pre season medical training and monthly drills, and checked regularly to ensure function.
Here are some basics on the components:
Medical grade oxygen should be used in a medical incident, to provide a high concentration of purified oxygen. The cylinder will offer 20-30 minutes on a medium/high flow setting, and requires a 3 year refill and 5 year hydrostatic pressure test or replacement, which is not available in all ports so plan ahead. The pin-index regulator should be mounted on the cylinder to protect the rubber bodox seal, and all components carefully secured in the strapping system within a water resistant bag, or waterproof if carried on tenders.
A good safety check is to slowly open the cylinder valve, check for audible leaks and the correct pressure volume on the dial, and then close the valve and drain the system by opening the flow valve or demand valve, and of course always following all standard oxygen safety protocols.
BAG VALVE MASK
A slightly spacey looking device, which you see regularly on medical tv shows. For use when a casualty is not breathing sufficiently (under 8 breaths per minute), or when someone stops breathing completely, we start with 30 compressions followed by our 2 breaths with the BVM. Use a c grip to hold the mask, and lift the chin with the same hand, connect oxygen using the universal tubing from a face mask and start on high flow (15-20 LPM) titrating down based on the pulse oximeter Sp02 reading. Squeeze the top of the chamber to deliver the breaths, aiming to compress to the volume of a can of coke.
NON REBREATHER MASK
The go to for oxygen delivery to a breathing casualty post trauma, smoke inhalation, severe breathing difficulties, or with severe pain. Start with high flow oxygen – 15-20 litres per minute, weaning down every few minutes to aim for a 94% oxygen level on the pulse oximeter.
It is always important to monitor a casualty on oxygen as the masks pose a suffocation risk without oxygen flow.
If a crew member or guest approaches you feeling unwell with no obvious injury, for example complaining of central chest pain during a heart attack, we would check the oxygen level and place nasal cannula in the tip of the nose looping behind the ears, commencing a low flow of oxygen – 4-6 litres per minute – weaning up as required to aim for that all important 94% Sp02 (oxygen level). A good tool for anyone who won’t tolerate a mask well – e.g. a child who finds the mask too scary & overwhelming.
This is a useful device that can deliver high percentage high pressure oxygen via a mask, by either pressing a button until the chest rises in CPR breaths, or place over the mouth for breath activation in a conscious casualty. Highly recommended for dive incidents to move nitrogen from the system. This device also conserves oxygen supplies over a longer period.
A simple device to quickly provide CPR breaths while the bag valve mask or demand valve is set up. Remember to tilt the chin up to open the airway during use.
GUEDEL AIRWAY OR NASOPHARYNGEAL AIRWAY
Can be utilised for unconscious casualties to stop the tongue rolling back and blocking the airway.
Choose a size by finding the one that best fits between the corner of the patients’ ear and corner of the mouth.
Insert upside down (in a u shape position) and twist over the tongue, (ending in an n shape position).
A guedel provides no protection from vomit – turn the casualty on the side, remove the guedel and clear the airway, then replace with a clean guedel. Should you be unable to access the mouth if the there is jaw damage from a fracture an alternative is a nasopharyngeal, a tube designed to insert in the nasal passageway to secure an open airway from the back of the throat.
Oxygen administration should always be conducted under Doctors or professional medical personnel guidance.
Check out your oxygen kits onboard and get in touch if you require any advice or guidance.
Medical Support OffShore (MSOS)
By Nick Stael Von Holstein