DKW 2 Physiology

Section Two
RESET
Diving Physiology
How the human body reacts to the experience of scuba diving is complex and fascinating. In fact, many divers nd it the most interesting aspect of diving theory. Certainly, it is one of the most important. But regardless of the specic mechanisms involved, changes occur to divers because of two vital factors: 1. The mechanical effects on the various air spaces of our body brought about by rapid changes in pressure. (Sometimes referred to as the direct effects of pressure.) 2. The physiological consequences of breathing gases at higher partial pressures than at the surface. (Sometimes referred to as the indirect effects of pressure.) The purpose of this section is to help you evaluate your understanding of these phenomena. Without an understanding of these vital concepts, your knowledge of diving theory cannot be considered complete. In addition, you will nd that some of the questions asked in this section will require an understanding of the concepts introduced in Section One. Therefore, if it has been a while since you completed Section One, you may wish to briey review those objectives related to the behavior of gases before proceeding.
Objective 2.1
Identify the substance within the blood that aids in the transport of oxygen, and in what component of the blood this substance is contained.
Resources:
Encyclopedia, Chapter Five, under the heading of Blood
Exercises:
1. Oxygen is efciently transported throughout the body because of a substance called _____________, which is contained in the _____________. a. oxidative metabolism/blood b. plasma/arteries c. protein/heart d. hemoglobin/red blood cells
Section Two: Diving Physiology
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2. If the blood did not contain the substance identied in the above question, blood would have to circulate how many times faster to keep up with the bodys demand for oxygen _____________? 3. Large amounts of carbon dioxide can be carried by the circulatory system back to the lungs for expiration primarily because carbon dioxide: a. can easily dissolve in the plasma. b. can easily combine with the hemoglobin. c. can be converted into bicarbonate. d. is an inert gas like nitrogen.
Objective 2.2
Explain how proper diving techniques and equipment can help avoid exhaustion and excessive buildup of carbon dioxide.
Resources:
Encyclopedia, Chapter Five, under the heading of Responses to Breathing with Equipment
Exercises:
1. The practice of breathing deeply when scuba diving is important in order to compensate for the: a. increased dead-air space resulting from the snorkel or regulator. b. reduced lung volume resulting from compression of the chest. c. increased amount of alveolar carbon dioxide. d. All of the above are correct. 2. The practice of breathing slowly when scuba diving is important in order to: a. minimize resistance caused by turbulence in the airways. b. compensate for the decrease in energy from immersion in cold water. c. avoid the potential for thoracic squeeze. d. All of the above are correct.
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Diving Knowledge Workbook
Objective 2.3
Explain the physiological mechanism by which voluntary hyperventilation enables a diver to extend breath-holding time.
Resources:
Encyclopedia, Chapter Five, under the heading of Responses to Breath-Hold Diving
Exercises:
1. When a breath-holding diver submerges in cold water, his heart rate will: a. increase. b. decrease. c. remain unchanged. d. uctuate. 2. To reduce the demand for oxygen while breath-hold diving, the diver should: a. breathe pure oxygen before submerging. b. move slowly and deliberately while underwater. c. take a few rapid, deep breaths before submerging. d. All of the above are correct. 3. To reduce the alveolar carbon dioxide level before a breath-hold dive, the diver should: a. get plenty of rest. b. move slowly and deliberately while underwater. c. take a few rapid, deep breaths before submerging. d. All of the above are correct.
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Objective 2.4
Explain the physiological mechanism that causes a shallow-water blackout and why this condition usually occurs during ascent rather than descent.
Resources:
Encyclopedia, Chapter Five, under the heading of Hypocapnia
Exercises:
1. The reex respiratory center regulates breathing based primarily on the level of _____________ in the blood. a. oxygen b. nitrogen c. carbon dioxide d. All of the above depending upon circumstance. 2. Hypoxia results when the divers carbon dioxide level cannot accumulate to a level high enough to stimulate breathing before the tissues consume the available oxygen. True False 3. Blackout normally occurs on ascent because: a. the divers energy expenditure increases. b. the partial pressure of the alveolar oxygen rapidly decreases. c. the partial pressure of the alveolar carbon dioxide rapidly decreases. d. the decreasing pressure causes a carotid sinus reex.
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Objective 2.5
Explain the physiological mechanism that causes a carotid-sinus reex, and how this affects the diver.
Resources:
Encyclopedia, Chapter Five, under the heading of Carotid-Sinus Reex
Exercises:
1. The carotid-sinus receptors, which are located in the carotid arteries, stimulate the _____________, which is located in the _____________. a. thyroid/throat b. cardioinhibitory center/brain c. S-A node/heart d. adrenal glands/kidneys 2. The carotid-sinus reex is caused by an excessively tight a. exposure suit or boots that constrict the feet. b. exposure suit that constricts the thorax. c. exposure suit or hood that constricts the neck. d. mask strap that constricts the head. 3. When the carotid-sinus receptors detect high pressure, they cause the heart to: a. slow down. b. speed up. c. stop momentarily. d. increase pressure.
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Objective 2.6
Explain the physiological effect of increased carbon monoxide levels (including cigarette smoking) on the diver and how they can be avoided.
Resources:
Encyclopedia, Chapter Five, under the heading of Carbon Monoxide Poisoning
Exercises:
1. Carbon monoxide is difcult to detect because it: a. is inert. b. has a sedating effect on the diver. c. is odorless and tasteless. d. All of the above are correct. 2. Carbon monoxide bonds with hemoglobin over _____________ times more readily than oxygen can, and takes _____________ for the circulatory system to eliminate it. a. 200/8-12 hours b. 100/4-6 hours c. 50/2-4 hours d. 20/30 minutes 3. The symptoms of carbon monoxide poisoning are not as noticeable at depth because: a. high levels of oxygen are dissolved in the plasma allowing tissues to meet their oxygen requirement. b. high levels of nitrogen sedate the divers central nervous system, slowing his metabolism. c. lower levels of carbon dioxide help to counteract the effects of carbon monoxide. d. lower levels of oxygen make the brain less sensitive and alert. 4. Smoking cigarettes prior to diving can raise the carbon monoxide level _____________ times above normal, which in turn _____________. a. 2/makes it harder to breath b. 3-12/impairs oxygen transport and carbon dioxide elimination c. 20-40/increases the risk of a lung-expansion injury d. 100/increases the risk of heart attack and stroke
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Objective 2.7
Explain the physiological mechanism of decompression sickness (DCS), and list the common susceptibility factors that can contribute to its occurrence.
Resources:
Encyclopedia, Chapter Five, under the heading of Inert Gas Absorption
Exercises:
1. If all of our tissues are essentially comprised of water, why dont they all absorb and eliminate nitrogen at about the same rate?
2. Why does DCS occur to recreational divers upon surfacing rather than while they are at depth?
3. Divers succumb to decompression sickness because in humans any amount of supersaturation of the tissues with nitrogen will result in signicant bubble formation. True False 4. The various factors that increase the divers susceptibility to decompression sickness relate primarily to: a. tissue half-times. b. physical conditioning. c. changes to respiration. d. changes to circulation.
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Objective 2.8
Dene the term silent bubbles as it relates to decompression sickness.
Resources:
Encyclopedia, Chapter Five, under the heading of Inert Gas Release
Exercises:
1. The term silent bubbles refers to bubbles that: a. do not move, such as those that cause decompression sickness in the joints. b. cannot be heard with any form of electronic sensors. c. are so small they do not cause signs and symptoms of decompression sickness. d. appear and disappear very quickly. 2. What is the device used to detect the presence of silent bubbles?
3. Silent bubbles are thought to form because of the presence of: a. fat particles in the blood stream. b. impurities in the divers air supply. c. gas seeds (micronuclei) d. changes in blood chemistry brought about by high levels of nitrogen.
Objective 2.9
Explain why individuals with decompression sickness (DCS) are given pure oxygen as a rst aid measure.
Resources:
Encyclopedia, Chapter Five, under the headings of Inert Gas Absorption Physiological Rationale for First Aid and Treatment of DCS and First Aid and Treatment for Lung Overexpansion Injuries
Exercises:
1. Why does DCS in recreational divers involve nitrogen bubbles but not oxygen bubbles?
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2. Breathing pure oxygen aids the individual with decompression sickness because it: a. enables the body to metabolize nitrogen more quickly. b. increases the pressure gradient between the nitrogen pressure in the tissues and the alveolar nitrogen pressure. c. decreases the pressure gradient between the nitrogen pressure in the tissues and the alveolar nitrogen pressure. d. helps reduce the size of the bubbles.
Objective 2.10
Explain the cause of nitrogen narcosis, state the approximate depth at which the disorder occurs and list three common signs/symptoms.
Resources:
Encyclopedia, Chapter Five, under the heading of Gas Narcosis
Exercises:
1. It is believed that nitrogen narcosis results from: a. disruptions in the transmissions between nerve cells. b. extravascular bubble formation in the brain. c. a severely decreased sensitivity to pain caused by silent bubbles. d. mechanisms that are completely unknown to science. 2. The signs and symptoms of nitrogen narcosis normally begin to occur at approximately what depth? a. 15 metres/50 feet b. 30 metres/100 feet c. 45 metres/150 feet d. 60 metres/200 feet 3. List the three primary signs/symptoms of nitrogen narcosis: a. b. c.
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Objective 2.11
Dene the term barotrauma, and explain how it can occur to the lungs, sinuses and ears of the diver during both ascent and descent.
Resources:
Encyclopedia, Chapter Five, under the heading of Problems in Body Air Spaces
Exercises:
1. The term barotrauma literally means: ___________________________________________ 2. Other than potential damage to the ear drum, an excessively forceful Valsalva maneuver can result in a(n): a. oval window rupture b. round window rupture c. eustachian tube rupture d. All of the above are correct 3. Severe lung squeeze can occur in shallow depths in which of the following conditions? a. A skin (breath-hold) diver hyperventilates prior to descent. b. A scuba diver descends taking excessively large breaths. c. A skin diver (breath-hold) descends with a normal lung volume. d. A skin diver descends with his lungs nearly empty.
Objective 2.12
Dene the term vertigo and explain the mechanism by which this normally occurs in the diver.
Resources:
Encyclopedia, Chapter Five, in the sidebar article entitled Summary of Ear and Sinus Barotrauma Treatment
Exercises:
1. Vertigo is a medical term meaning: a. dizziness. b. infection of the inner ear. c. the inability to hear. d. the ear drum has been ruptured.
2-10 Diving Knowledge Workbook
2. Vertigo can be caused by: a. ear squeeze. b. inner ear barotrauma. c. decompression sickness. d. All of the above are correct.
Objective 2.13
Describe the basic anatomy of the ear and which areas/structures are most affected by changing pressures.
Resources:
Encyclopedia, Chapter Five, under the heading The Ears
Exercises:
1. Sound vibrations are transferred from the outer to the inner ear via the: a. oval window. b. round window. c. cochlea. d. ossicles. 2. The vestibular canals are located in the_____________ and are responsible for _____________. a. inner ear/balance b. middle ear/sound transmission c. outer ear/channeling sound waves to the ear drum d. brain/transmitting nerve impulses (sound) 3. Which portion of the ear is most affected by changes in pressure? a. outer ear b. middle ear c. inner ear d. All areas are equally affected.
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Objective 2.14
Compare and contrast the various signs/symptoms of decompression sickness and air embolism.
Resources:
Encyclopedia, Chapter Five, under the heading Decompression Sickness and Lung Overexpansion Injuries PADI Rescue Diver Manual, Chapter Four, under the heading Pressure Related Injuries
Exercises:
1. A symptom of air embolism may be _____________, while two symptoms of decompression sickness may be _____________ and _____________. a. pain in the joints, fatigue/sudden unconsciousness b. sudden unconsciousness/pain in the joints and fatigue c. coughing of bloody froth/dizziness and confusion d. cherry red nail beds/paralysis 2. In terms of the location of symptoms, air embolism is characterized by _____________, while decompression sickness is characterized by _____________. a. involvement of the head and neck/involvement of the arms and legs b. involvement of the respiratory center/involvement of the central nervous system c. involvement of both sides of the body, either upper or lower/involvement of only one side of the body d. involvement of only one side of the body/involvement of both sides of the body, either upper or lower 3. In terms of the change in symptoms, air embolism is characterized by _____________, while decompression sickness is characterized by _____________. a. symptoms tending to improve as a result of rst aid/usually no change or worsening of condition b. usually no change or worsening of condition/symptoms tending to improve as a result of rst aid c. gradual worsening over time/gradual improvement over time d. gradual improvement over time/gradual worsening over time
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Objective 2.15
State the most serious form of lung-expansion injury in diving and how it occurs, and what factors can contribute to its occurrence.
Resources:
Encyclopedia, Chapter Five, under the heading Lung Overexpansion Injuries PADI Rescue Diver Manual, Chapter Four, under the heading Pressure Related Injuries
Exercises:
1. The most serious form of lung-expansion injury is a(n) _____________ because air bubbles enter the _____________. a. pneumothorax/thorax b. pneumothorax/lung tissues c. air embolism/arterial circulation d. air embolism/venous circulation 2. Explain how a lung-expansion injury can occur even to a diver who is breathing normally.
3. Surfactant is a substance that coats the inner surfaces of the _____________ and helps prevent them from _____________. a. bronchioles and alveoli/rupturing b. bronchioles and alveoli/collapsing c. veins and arteries/collapsing d. veins and arteries/rupturing
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Section Two
Answer Key
Objective 2.1
Identify the substance within the blood that aids in the transport of oxygen, and in what component of the blood this substance is contained.
Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge
1. (d) Oxygen is efciently transported throughout the body because of a substance called hemoglobin, which is contained in the red blood cells. Red blood cells which comprise 45% of the blood mass contain the protein hemoglobin. In fact, the chemical reaction between hemoglobin and oxygen is what makes the cells red. White blood cells primarily ght infections. The plasma is the uid in which all the other components are suspended. 2. If the blood did not contain the substance identied in the above question, blood would have to circulate how many times faster to keep up with the bodys demand for oxygen? 15 to 20 times. 3. (c) Large amounts of carbon dioxide can be carried by the circulatory system back to the lungs for expiration primarily because carbon dioxide: can be converted into bicarbonate. Carbon dioxide the waste product of oxidative metabolism is a very reactive compound. To efciently transport as much of it as possible back to the lungs, most of it is turned into another compound bicarbonate. Once back at the lungs, the bicarbonate is converted again into carbon dioxide and released through respiration.
Section Two: Answer Key
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Objective 2.2
Explain how proper diving techniques and equipment can help avoid exhaustion and excessive buildup of carbon dioxide.
Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge
1. (d) The practice of breathing deeply when scuba diving is important in order to compensate for the: All of the responses are correct. Deep breathing helps exchange more air, reducing the effect of increased dead-air spaces. It also compensates for the reduction in lung volume caused by the increased pressure on the chest (thorax) due to submersion. Finally, deep breathing helps eliminate the higher than normal level of carbon dioxide in the alveoli brought about by the increased resistance of breathing while submerged. 2. (a) The practice of breathing slowly when scuba diving is important in order to: minimize resistance caused by turbulence in the airways. Slower breathing reduces the tendency for the air ow to become turbulent. (See gure in Chapter Five of the Encyclopedia) Turbulence results in increased resistance and, therefore, an increased breathing effort.
Objective 2.3
Explain the physiological mechanism by which voluntary hyperventilation enables a diver to extend breath-holding time.
Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge
1. (b) When a breath-holding diver submerges in cold water, his heart rate will: decrease. While it is true that if we hold our breath on land our heart rate will increase, just the opposite can occur when we are immersed in water. The phenomenon of decreasing heart rate upon submersion is referred to as the mammalian diving reex. Although humans have far less of a response, it is common to all diving mammals. (This accounts for the incredible breath-hold capabilities of marine mammals.) However, in order for the phenomenon to occur, the face must be immersed, or at least moistened, in cold water. 2. (b) To reduce the demand for oxygen while breath-hold diving, the diver should: move slowly and deliberately while underwater. This is mere common sense. To reduce the demand for oxygen, we must reduce our energy expenditure. Breathing pure oxygen prior to diving will, of course, increase the amount available to us. But, it will do nothing to reduce the demand. Likewise, hyperventilation will increase our breathholding capacity by reducing the amount of carbon dioxide, but it will not reduce the demand for oxygen. Only a reduction in work can reduce the demand for oxygen.
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3. (c) To reduce the alveolar carbon dioxide level before a breath-hold dive, the diver should: take a few rapid, deep breaths before submerging. A few deep breaths prior to diving will help ush carbon dioxide out of the lungs. Slow movement will reduce oxygen demand during the dive, but will do nothing to decrease the carbon dioxide level before the dive. Likewise, the amount of rest will have no impact on reducing the predive level of carbon dioxide. Only hyperventilation will do this.
Objective 2.4
Explain the physiological mechanism that causes a shallow-water blackout and why this condition usually occurs during ascent rather than descent.
1. (c) The reex respiratory center regulates breathing based primarily on the level of carbon dioxide in the blood. A seemingly paradoxical phenomenon is that the factor controlling the urge to breathe is not primarily the lack of oxygen in our blood. Instead, its an elevated level of carbon dioxide. Incidentally, the noted dive table physiologist J.S. Haldane was one of the scientists who discovered this fact. 2. Hypoxia results when the divers carbon dioxide level cannot accumulate to a level high enough to stimulate breathing before the tissues consume the available oxygen. True. This is precisely why an overextended, breath-holding diver blacks out. Although the tissues are hypoxic in need of oxygen the urge to breathe is suppressed because of the low level of carbon dioxide inuenced by hyperventilation. If the tissues continue to be air starved, they begin to cease functioning. Eventually, the breath-hold diver will become unconscious. 3. (b) Blackout normally occurs on ascent because: the partial pressure of the alveolar oxygen rapidly decreases. At depth, the elevated partial pressure of alveolar oxygen can be sufcient to meet the tissues demand. However, when the diver ascends, the oxygen partial pressure quickly drops (For example, an ascent from 10 metres/33 feet will result in a reduction of the partial pressure by 50%). Now, suppose the diver barely had enough oxygen at depth to remain conscious and functional. A severe drop would be enough to decrease the level to a point the body could not tolerate. So, although the diver could continue to function at depth, he will black out as he ascends to the surface due to the abrupt decrease in the oxygen partial pressure.
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Objective 2.5
Explain the physiological mechanism that causes a carotid-sinus reex, and how this affects the diver.
Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge
1. (b) The carotid-sinus receptors, which are located in the carotid arteries, stimulate the cardioinhibitory center, which is located in the brain. Although the impulse that simulates the heart originates in the heart (sino-arterial node), the brain has the capability to inhibit this impulse. This is what occurs in a carotid-sinus reex. The heart rate slows down to a point where it is unable to maintain sufcient blood ow to the brain. 2. (c) The carotid-sinus reex is caused by an excessively tight: exposure suit or hood that constricts the neck. Because the receptors are in the carotid arteries (neck), anything constricting that area could cause the reex to occur. Dry suit neck seals are particularly noted for this. 3. (a) When the carotid-sinus receptors detect high pressure, they cause the heart to: slow down. In essence, the brain is fooled. The pressure the receptors are sensing results from the squeeze of the hood or exposure suit, not the pressure within the artery.
Objective 2.6
Explain the physiological effect of increased carbon monoxide levels (including cigarette smoking) on the diver and how they can be avoided.
1. (c) Carbon monoxide is difcult to detect because it: is odorless and tasteless. People mistakenly believe that carbon monoxide smells like car exhaust. This is not the case. The smell given off from internal combustion engines results from hydrocarbon emissions. Carbon monoxide itself has no odor. Although a diver will eventually become unconscious, this is not because of any sedative effect, but rather due to hypoxia. Clearly, carbon monoxide is not inert (chemically inactive).
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2. (a) Carbon monoxide bonds with hemoglobin over 200 times more readily than oxygen can, and takes 8-12 hours for the circulatory system to eliminate it. The molecular structure of carbon monoxide enables it to combine with hemoglobin more readily than can oxygen 200 times more readily. In fact, the bonding of carbon monoxide and hemoglobin is so strong that it takes over eight hours for it to be released from the bloodstream. 3. (a) The symptoms of carbon monoxide poisoning are not as noticeable at depth because: high levels of oxygen are dissolved in the plasma allowing tissues to meet their oxygen requirement. Remember that tissues receive oxygen in two ways. Primarily they are supplied by oxygen carried by the hemoglobin. But, they are also supplied by free oxygen dissolved in plasma. With the increased partial pressure at depth, the amount of oxygen in solution could be sufcient to provide the tissues demand. The carbon monoxide would then have no noticeable effect. However, as the partial pressure drops during ascent, the oxygen in the hemoglobin will be needed. However, if the hemoglobin is locked-up by carbon monoxide, then insufcient oxygen will be delivered to the tissues. 4. (b) Smoking cigarettes prior to diving can raise the carbon monoxide level 3-12 times above normal, which in turn impairs oxygen transport and carbon dioxide elimination. One of the primary by-products of burning tobacco is carbon monoxide. Once in the bloodstream it combines with the hemoglobin, effectively locking out the oxygen. In addition, because hemoglobin also transports carbon dioxide on its return to the lungs, it also hinders the transport of this gas. The evidence for not smoking is overwhelming for anyone. For divers even more so. Dont smoke, particularly if you are a diver!
Objective 2.7
Explain the physiological mechanism of decompression sickness (DCS), and list the common susceptibility factors that can contribute to its occurrence.
1. If all of our tissues are essentially comprised of water, why dont they all absorb and eliminate nitrogen at about the same rate? Although our tissues are comprised primarily of water, there are some important differences among tissues that affect their gas absorption characteristics. First, tissues have differing densities. Bone, for example, is more dense than skin. This will affect how gas is diffused once it reaches the tissue. Secondly, the blood supply differs among tissues. Therefore, tissues receiving more blood supply will have more gas delivered and eliminated.
Section Two: Answer Key 2-19
2. Why does DCS occu r to recreational divers upon surfacing rather than while they are at depth? Bubble formation cannot occur until the tissues become supersaturated (ie. hold more gas than the ambient pressure). Supersaturation cannot occur, however, until the ambient pressure is reduced upon ascent. As saturation divers have shown us, humans can remain at depth indenitely and not get DCS. The problem occurs only when we ascend. 3. Divers succumb to decompression sickness because in humans any amount of supersaturation of the tissues with nitrogen will result in signicant bubble formation. False. Humans can tolerate some degree of supersaturation. Otherwise, we would get the bends by merely going to the top of a skyscraper in an elevator, or driving up a mountain. The important factor is determining how much supersaturation can be tolerated without the formation of nitrogen bubbles. This is what decompression models seek to explain. 4. (d) The various factors that increase the divers susceptibility to decompression sickness relate primarily to: changes to circulation. Two factors affect gas absorption the density of the tissues and the blood ow. We can help control only one of these the amount of blood ow (circulation) getting to the tissues. In reviewing the various susceptibility factors, notice how most involve (to some degree) circulation: 1) decreased circulation efciency with age; 2) increased circulation from exercise; 3) changes in circulation during alcohol consumption and 4) recent illness/injury. The only factor that takes tissue density in consideration is obesity. And it is unclear as to what effect this really has upon recreational divers.
Objective 2.8
Dene the term silent bubbles as it relates to decompression sickness (DCS).
1. (c) The term silent bubbles refers to bubbles that: are so small they do not cause signs and symptoms of decompression sickness. The term silent simply refers to the fact that the bubbles are so small that they apparently cause no symptoms of DCS. It has nothing to do with the ability to detect them.
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2. Silent bubbles can, in fact, be detected using ultrasound technology. A pre-cordial Doppler Ultrasound Flowmeter can enable scientists to hear the silent bubbles as they travel to the lungs in the venous circulation. This phenomena is used as a criterion in testing decompression models and some dive tables/computers. 3. (c) Silent bubbles are thought to form because of the presence of: gas seeds (micronuclei). Just as rain drops require dust particles on which to form, it is theorized that nitrogen bubbles need some form of seed. These seeds are termed gas micronuclei - unwettable microscopic gas pockets on tissue surfaces that act as seeds for bubble growth.
Objective 2.9
Explain why individuals with decompression sickness (DCS) are given pure oxygen as a rst aid measure.
1. Why does DCS in recreational divers involve nitrogen bubbles but not oxygen bubbles? Nitrogen is physiologically inert, meaning that it is not used in the metabolic process. Therefore, whatever nitrogen is absorbed by the body as the ambient pressure increases must be eliminated as the ambient pressure is reduced. In decompression sickness, bubbles form because the nitrogen cannot escape quickly enough to remain in solution. Oxygen bubbles do not form because the oxygen we breathe is used up in the metabolic process. 2. (b) Breathing pure oxygen aids the individual with decompression sickness because it: increases the pressure gradient between the nitrogen pressure in the tissues and the alveolar nitrogen pressure. From our discussion of diving physics you should remember that the difference in the pressure within a liquid (gas tension) and the gas in contact with it is referred to as the pressure gradient. When this condition occurs, the gas within the liquid and that in contact with the liquid will attempt to equalize. A large pressure gradient is said to create a high driving force, meaning the gas exchange will take place rapidly. In decompression sickness the tissues of the body contain a high level of nitrogen. The alveolar air also has nitrogen within it, but less than what is within the
tissues. As a result, there is a pressure gradient between the nitrogen in the tissues (high) and the nitrogen within the alveolar air (low). Hence, the nitrogen begins to come out. But, if instead of air the diver breathes oxygen, there will be no or very little alveolar nitrogen. This will further increase the pressure gradient between the tissue nitrogen levels and the alveolar nitrogen levels. The result is a signicant increase in the driving force of the tissue nitrogen, thus aiding in its elimination.
Objective 2.10
Explain the cause of nitrogen narcosis, state the approximate depth at which the disorder occurs and list three common signs/symptoms.
1. (a) It is believed that nitrogen narcosis results from: disruptions in the transmissions between nerve cells. Though not fully understood, it is believed that nitrogen narcosis results from disruptions in nerve impulse transmissions. Inert gases particularly when breathed under pressure have the capacity to cause this disruption. The degree of the disruption depends upon how well the gas dissolves into the lipid (fat) tissues. As we are all aware, nitrogen has no effect at surface pressure. But, when breathed under sufcient pressure, it too can cause the disruption of nerve impulse transmissions. 2. (b) The signs and symptoms of nitrogen narcosis normally begin to occur at approximately what depth? 30 metres/100 feet. In most people the signs/symptoms of nitrogen narcosis will begin to appear at approximately 30 metres/100 feet. However, this is a highly individual consideration. Many divers have succumbed to the disorder at much shallower depths, particularly in instances where drugs or alcohol have been consumed. 3. List the three primary signs/symptoms of nitrogen narcosis: a) poor judgment; b) decreased coordination; and c) a feeling of false security. Other signs/symptoms include foolish behavior, anxious or uncomfortable feelings and a general disregard for safety.
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Objective 2.11
Dene the term barotrauma, and explain how it can occur to the lungs, sinuses and ears of the diver during both ascent and descent.
1. The term barotrauma literally means: pressure injury (baro = pressure, trauma = injury). 2. (b) Other than potential damage to the ear drum, an excessively forceful Valsalva maneuver can result in a(n): round window rupture. During an excessively forceful Valsalva maneuver, increased pressure in the chest inhibits the ow of blood returning to the heart. As the venous blood backs up it momentarily raises the pressure of the cerebrospinal uid. (Its the job of the venous circulation to absorb this uid that bathes the nerves.) As the cerebrospinal uid includes the perilymph within the inner ear, the pressure within the inner ear rises. This rise in pressure causes the round window to bulge outward. If the pressure continues to build, the bulge can grow to a point where rupture will occur. This is a primary reason why divers are warned to be cautious when clearing their ears using the valsalva maneuver. 3. (d) Severe lung squeeze can occur in shallow depths in which of the following conditions? A skin diver descends with his lungs nearly empty. Although rare, thoracic squeeze can be life threatening. The mechanics are easy to understand if you think back to our discussion on diving physics. An expandable container like our lungs when taken to depth will be squeezed by the pressure, resulting in a decrease in volume. If the container (lung) is full, the descent will merely reduce its volume. However, our lungs cannot be reduced below their empty (residual) volume without the potential for damage. Therefore, if a rapid descent is begun after a forceful exhalation, a reduction in lung volume below the residual level will rapidly occur. This could result in severe tissue damage and bleeding.
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Objective 2.12
Dene the term vertigo and explain the mechanism by which this normally occurs in the diver.
1. (a) Vertigo is a medical term meaning: dizziness. Vertigo is dened as a disoriented state where the individual has the feeling of rotating or spinning. 2. (d) Vertigo can be caused by: All of the responses are correct. Various forms of ear squeeze can cause vertigo. Examples are: cold water entering the middle ear as a result of a ruptured ear drum; and a reverse block in one of the eustachian tubes allowing one ear to depressurize on ascent but not the other. As the sense of balance is controlled by the inner ear, damage to this organ usually results in some form of vertigo. Finally, in rare but severe cases, bubble formation from decompression sickness can occur in the inner ear and result in vertigo.
Objective 2.13
Describe the basic anatomy of the ear and which areas/structures are most affected by changing pressures.
1. (d) Sound vibrations are transferred from the outer to the inner ear via the: ossicles. The ossicles are the series of bones that are attached at one end to the tympanic membrane (ear drum) of the outer ear, and are connected to the oval window of the inner ear. The mechanical advantage resulting from the arrangement of the ossicles also amplies the vibrations as they pass from the outer to the inner ear. 2. (a) The vestibular canals are located in the inner ear and are responsible for balance. In addition to enabling us to hear, the inner ear also controls the sense of balance via the vestibular or semi-circular canals. These canals are arranged in such a way that the movement of uid within them can be interpreted by the brain to determine balance and orientation.
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3. (b) Which portion of the ear is most affected by changes in pressure? middle ear. The outer ear structures (canal, lobes) are open to the water, and are unaffected by changes in ambient pressure. Like any air-lled structure of the body, the middle ear is affected by changes in ambient pressure. Although what occurs in the middle ear can, in turn, affect the inner ear, the inner ear itself is not directly affected by the change in ambient pressure because it is uid-lled.
Objective 2.14
Compare and contrast the various signs/symptoms of decompression sickness and air embolism.
1. (b) A symptom of air embolism may be sudden unconsciousness, while two symptoms of decompression sickness may be pain in the joints and fatigue. In air embolism, air bubbles escape directly into the pulmonary vein, are transported to the heart and then most likely to the brain. The bubbles begin to expand upon ascent and eventually block arterial circulation when they become too large to pass through the blood vessels. Much like a stroke, this blockage cuts off vital blood ow to the brain, usually resulting in almost immediate unconsciousness. Coughing of bloody froth is actually not a very common sign. On the other hand, decompression sickness results from nitrogen elimination occurring so quickly due to a reduction in ambient pressure that it comes out of solution and forms bubbles. This condition does not occur immediately, but rather over time (taking usually 30 minutes or more). Although not fully understood, many believe that joint pain is a result of extravascular bubble formation in the ligaments and tendons of the joints. 2. (d) In terms of the location of symptoms, air embolism is characterized by involvement of only one side of the body, while decompression sickness is characterized by involvement of both sides of the body, either upper or lower. Air embolism often resembles a stroke the entire right or left side of the body is affected, according to whichever side of the brain is involved. (The right brain controls the motor coordination of left side of the body and vice versa). Therefore, symptoms of air embolism appear likewise. In decompression sickness, particularly when it involves the central nervous system, the symptoms are more akin to paralysis. In this case both sides of the body upper or lower are affected, according to where in the spinal column the bubble damage has occurred.
3. (a) In terms of the change in symptoms, air embolism is characterized by symptoms tending to improve as a result of rst aid, while decompression sickness is characterized by usually no change or worsening of condition. In cases of embolism, a victim will often appear to improve once they are treated for shock and begin breathing pure oxygen. In cases of decompression sickness, the condition requires time to develop and, therefore, requires time and aggressive treatment to improve. Immediate rst aid measures will tend to have little consequence on bubble growth. Symptoms will often not show improvement as a result of rst aid.
Objective 2.15
State the most serious form of lung-expansion injury in diving and how it occurs, and what factors can contribute to its occurrence.
1. (c) The most serious form of lung-expansion injury is a(n) air embolism because air bubbles enter the arterial circulation. Although all forms of lung-expansion injury are serious, air embolism is clearly the most serious. In this case, air bubbles enter the arterial circulation and similar to a stroke block blood ow. To make matters worse, the bubbles usually migrate to the brain; and in accordance with the laws of physics, the bubbles continue to expand as long as the diver ascends. No other lung-expansion problem has such immediately life-threatening consequences. 2. Explain how a lung-expansion injury can occur even to a diver who is breathing normally. Any obstruction that prevents the normal release of air from the lungs can cause overpressurization. These obstructions can occur for various reasons. Even though the diver may breathe normally, obstructions deep in the lungs may not allow air to escape. Various diseases such as asthma and other pulmonary disorders can cause these obstructions. However, a more prevalent cause of lung obstructions in divers are those resulting from smoking cigarettes, or diving after a severe chest cold. 3. (b) Surfactant is a substance that coats the inner surfaces of the bronchioles and alveoli and helps prevent them from collapsing. Because of the size and exibility of the structures of the lungs, the bronchioles and alveoli tend to collapse upon exhalation. To prevent these structures from remaining shut once they collapse, the walls of the bronchioles and alveoli are coated with a chemical referred to as a surfactant. Still another danger of cigarette smoking is that it destroys the surfactant, inhibiting the reopening of the bronchioles and alveoli.
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Section Analysis
From the answer key, identify any items marked "correct-guess" or "incorrect-lack of knowledge." These items represent important points of information or concepts you still might not fully understand. Check below any objectives that contained items with a "correct-guess" or "incorrect-lack of knowledge" response. Completing this section is an important step in determining your understanding of physiology as it relates to recreational diving. Condent Correct Responses Guess Total
Simple Mistake Incorrect Responses
Lack of Knowledge
Total
Objectives To Be Reviewed:
2.1 2.6 2.11 2.2 2.7 2.12 2.3 2.8 2.13 2.4 2.9 2.14 2.5 2.10 2.15
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DKW 2 Physiology

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DKW 2 Physiology

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Section Two

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Diving Physiology

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Diving Physiology

Diving Knowledge Workbook

Section Two: Answer Key

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Diving Knowledge Workbook

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Section Two: Answer Key

Diving Knowledge Workbook

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Diving Knowledge Workbook

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Diving Knowledge Workbook

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Section Two: Answer Key

Diving Knowledge Workbook

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Correct: Condent Guess Incorrect: Simple Mistake Lack of Knowledge

Diving Knowledge Workbook

Simple Mistake Incorrect Responses

Section Two: Answer Key

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