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Figure 21-2. Emergency Medical Equipment for TRCS.

ties to support an event requiring Advanced Cardiac Life Support. These drugs/equipment are not required to be in every dive kit when multiple chambers/kits are present in a single command.

21-9.3 Use of Emergency Kits. Unless adequately sealed against increased atmospheric pressure, sterile supplies should be resterilized after each pressure exposure, or, if not exposed, at six-month intervals. Drugs shall be replaced when their expiration date is reached. Not all drug ampules will withstand pressure. Stoppered multidose vials should be vented with a needle during pressurization and then discarded if not used.

21-9.3.1 Modification of Emergency Kits. Because the available facilities may differ on board ship, at land-based diving installations, and at diver training or experimental units, the responsible Diving Medical Officer or Diving Medical Technician will have to modify the emergency kits to suit the local needs. Both kits should be taken to the recompression chamber or scene of the accident. Each kit is to contain a list of contents. Each time the kit is opened, it shall be inventoried and each item checked for proper working order and then re-sterilized. Sterile supplies are to be provided in duplicate so that one set can be autoclaved while the other resides in the kit. The kits on-hand are inventoried, unopened, at four-month intervals. Normally, use of the emergency kit is to be restricted to the medical personnel. Concise instructions for administrating each drug are to be provided in the kit along with current American Heart Association Advanced Cardiac Life-Support

Table 21-7. Primary Emergency Kit.

Diagnostic Equipment

• Flashlight

• Stethoscope

• Otoscope (Ophthalmoscope)

• Sphygmomanometer (Aneroid type only, case vented for hyperbaric use)

• Reflex hammer

• Sterile safety pins or swab sticks which can be broken for sensory testing

• Tongue depressors

Emergency Treatment Equipment and Medications

• Oropharyngeal airways (#4 and #5 Geudel)

• Self-Inflating Clear Bag-Mask ventilator with medium adult mask NOTE: Some of these units do not have sufficient bag volume to provide adequate ventilation. Use a Laerdal Resusci Folding Bag II (Adult) or equivalent.

• Suction apparatus

• Nonflexible plastic suction tips (Yankauer Suction Tip)

• Large-bore needle and catheter (12 or 14 gauge) for cricothyrotomy or relief of tension pneumothorax

• Small Penrose drain, Heimlich valve, or other device to provide one-way flow of gas out of the chest

• Christmas tree adapter (to connect one-way valve to chest tube)

• Adhesive tape (2-inch waterproof)

• Elastic-Wrap bandage for a tourniquet (2- and 4-inch)

• Tourniquet

• Bandage Scissors

• #11 knife blade and handle

• Curved Kelly forceps

• 10% povidone-iodine swabs or wipes

• 1% lidocaine solution

NOTE 1: One Primary Emergency Kit is required per chamber system (i.e., TRCS requires one).

Protocols. In untrained hands, many of the items can be dangerous. Remember that as in all treatments YOUR FIRST DUTY IS TO DO NO HARM.

Table 21-8a. Secondary Emergency Kit (sheet 1 of 2).

Emergency Airway Equipment

• Cuffed endotracheal tubes with adapters (7-9.5 mm)

• Syringe and sterile water for cuff inflation (10 cc)

• Malleable stylet (approx. 12" in length)

• Laryngoscope blades (Mcintosh #3 and #4, Miller #2 and #3)

• Sterile lubricant

• Soft-rubber suction catheters

• #32F and #34F latex rubber nasal airways

Drugs

• Lactated Ringer's Solution (3 ea 1-liter bags)

• Normal saline (2 ea 1-liter bags, 4 ea 250-ml bags for mixing drugs)

• * Sodium bicarbonate for injection (8 ea mEg)

• * Dexamethasone for injection (4 ea 5-ml, 4 ea mg/ml)

• * Epinephrine (1 /10,000) for injection (4 ea 1-mg)

• * Diphenhydramine hydrochloride for injection (4 ea 50-mg)

• * Sodium phenytoin for injection (4 ea 250-mg)

• * Procainmide hydrochloride for injection (2 ea 1,000-mg)

• * Sterile water for injection

• Aspirin Tablets

• Aspirin rectal suppositories

NOTE 1: Only commands having recompression chambers with a Medical Officer attached shall maintain a portable monitor-defibrillator and those drugs listed with an asterisk (*).

NOTE 2: Whenever possible, preloaded syringe injection sets should be obtained to avoid the need to vent multidose vials or prevent implosion of ampules. Sufficient quantities should be maintained to treat one injured diver.

NOTE 3: One Secondary Emergency Kit is required per chamber system (i.e., TRCS requires one).

Table 21-8b. Secondary Emergency Kit (sheet 2 of 2).

Miscellaneous

• Nasogastric tube

• Urinary catheterization set with collection bag (Foley type)

• Catheter and needle unit, intravenous (16- and 18-gauge - 4 ea)

• Intravenous infusion sets (4)

• Intravenous infusion extension sets with injection ports (2)

• Straight and curved hemostats (2 ea)

• Blunt straight surgical scissors

• Thermometer (non-mercury type, high and low reading preferably)

• Wound closure instrument tray

• Needle driver

• Assorted suture material (with and without needles)

• Assorted scalpel blades and handle

• Surgical soap

• Sterile towels

• Gauze roller bandage, 1-inch and 2-inch, sterile

• 10% povidone-iodine swabs or wipes

NOTE: A portable oxygen supply with an E cylinder (approximately 669 liters of oxygen) is recommended whenever possible in the event the patient needs to be transported to another facility.

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