Summary Echm Uhms Recommendations For Treatment Of Di

ON SITE MANAGEMENT

First Aid ECHM

On Site First Aid - Oxygen 100% 1 C

On Site First Aid - Fluids (oral) 2 C

No In-Water Recompression 1 C

HOSPITAL-BASED THERAPY HBO ECHM

Hyperbaric Tx Hyperoxygenated Tables 1 C

Recompression (Other: e.g., USN TT6A/7 for AGE or recalcitrant DI cases)

Fluids ECHM

UHMS EBM

UHMS EBM

UHMS EBM

Fluid Therapy in General (Hospital Based)

2 C

-

-

Fluid Therapy (IV - Hospital based)

2 C

-

-

No Fluid Therapy D5W

1 C

1*

C

Fluid Therapy LR/crystalloids (Pain only/mild)

2 C

1

C

Fluid Therapy LR/crystalloids (Chokes)

2 C

2B

C

Fluid Therapy LR/crystalloids (Neuro DI)

2 C

1

C

Fluid Therapy LR/crystalloids (AGE)

2 C

2B

C

Fluid Therapy Colloids (Pain/Chokes/Neuro/AGE)

2 C

1/ 2B/1/2B

C

Drug Therapy

ECHM

UHMS EBM

Life Support Drug Therapy

2 C

-

-

Drug Therapy in General

3 C

-

-

Aspirin

3 C

2B

C

NSAIDs (AGE and Chokes)

3 C

2B

C

NSAIDs (pain only & neurological)

3 C

2B

B

Anti-coagulants (AGE, Neurological, Chokes)

3 C

2B

C

Anticoagulants (pain only)

3 C

3 y

C

Anticoagulants (leg immobility - DVT prev.)

- -

1

A

Corticosteroids

3 C

3 y

C

Lidocaine (AGE)

3 C

2A

B

Lidocaine (neuro DCS)

3 C

2B

C

Lidocaine (pain only, chokes)

3 C

3 y

C

* UHMS recommendations are classified inversely, i.e., D5W: Class 3 (harmful). However for the sake of uniformity it has been changed to the negative: No D5W: Class 1

y UHMS Class 3 suggests an agent is harmful, whereas ECHM type 3 indicates optional use. This is an area in need of more careful delineation

Experience with the use of Lidocaine / Lignocaine in other settings indicates that ataxia and perioral paresthesias are common. More serious toxic effects such as seizures can also occur.

Although the respective ECHM and UHMS recommendations were developed independently and were separated by significant time intervals, they reflect a remarkable degree of consensus. Additional study and harmonization is required in those areas where information is lacking and where differences exist between ECHM Type 3 (optional) and UHMS Class 3 (harmful) classifications.

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