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Manual De Medicina Subacuática E Hiperbárica

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Manual De Medicina Subacuática E Hiperbárica MANUAL DE MEDICINA SUBACUÁTICA E HIPERBÁRICA E. Salas Pardo J.M. García-Cubillana de la Cruz F. Samalea Pérez Servicio de Medicina Subacuática e Hiperbárica. Hospital General de la Defensa «San Carlos». San Fernando. Cádiz 2 Los criterios y opiniones vertidos en este Manual son responsabilidad de los coordinadores y autores de los mismos. Debido a que la Medicina es una ciencia en continua evolución, los autores y editores de este libro recuerdan que los datos recogidos en los presentes capítulos pueden no ser completos ni exactos. Por eso recomiendan a los usuarios de los mismos que contrasten la información con otras fuentes existentes. Fotos de portada: 1. Traje de buzo de gran profundidad. Centro de Buceo de la Armada. La Algameca, Murcia ( JM G-Cubillana, 1987). 2. Cámara Hiperbárica Hospital General Defensa San Carlos, San Fernando, Cádiz (JM G-Cubillana, 2005 ) 3. Buceadores con equipo de aire comprimido, Cádiz ( CBD «Escafandra», CN Elcano, 2005). Reservados todos los derechos. Queda autorizada la grabación de la versión digital de este manual en cualquier medio de almacenamiento de información y sistema de recuperación de datos. Queda autorizada la reproducción total o parcial de la versión digital de este manual siempre que se cite su procedencia. Patrocinado por: Laboratorios SALVAT, Gall, 30-36. 08950 Esplugues de Llobregat. Barcelona. España © 2007, Emilio Salas Pardo, Juan Manuel García-Cubillana de la Cruz, Fernando Samalea Pérez Depósito Legal: CA-850/07 Imprime: Imprenta La Isla. San Fernando. Cádiz. 3 AUTORES Andrés García José Antonio. Jefe de sección de traumatología. Hospital Universitario Puerta del Mar. Cádiz. Comité técnico ENBAD. Departamento médico FEDAS. Arias Garrido José Julián. Facultativo especialista de área de medicina intensiva. Servicio de cuidados críticos y urgencias. Hospital del SAS. Jerez de la Frontera (Cádiz). Carrasco Santos María Loreto. Capitán médico. Aptitud AB. Jefe de servicio de dermatología. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Cuadrado Olvera Salvador. Teniente enfermero. Aptitud AB. Servicio de medicina subacuática e hiperbárica. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Cuéllar Cariñanos José. Comandante médico. Aptitud AB. Adjunto del servicio de alergia. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). García-Cubillana de la Cruz Juan Manuel. Teniente coronel médico. Aptitud AB. Jefe de servicio de pediatría. Hospital General de la Defensa «San Carlos». San Fernando (Cádiz). Infante Pino Gonzalo. Comandante médico. Aptitud AB. Jefe de sanidad del Mando de Operaciones Especiales. Alicante. Lechuga Gómez José Antonio. Capitán enfermero. Aptitud AB. Servicio de medicina subacuática e hiperbárica. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). López Gómez Ana María. Comandante médico. Aptitud AB. Adjunto del servicio de neumología. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Martínez Vidal José Cirilo. Teniente coronel médico. Aptitud AB (Armada y Universidad de Alicante). Instructor internacional de buceo deportivo. Adjunto del servicio de medicina interna. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Mateo Lozano José Manuel. Capitán enfermero. Aptitud AB. Escuela de Suboficiales. San Fernando (Cádiz). Peral Pérez Francisco Luis. Médico del Servicio de Medicina Deportiva. Instituto Municipal del Deporte. Ayuntamiento de Cádiz. Rodríguez Díaz Alfonso. Teniente coronel médico. Aptitud AB. Jefe de servicio de otorrinolaringología. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Salas Pardo Emilio. Teniente coronel médico. Jefe de servicio de medicina subacuática e hiperbárica. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Samalea Pérez Fernando. Comandante médico. Adjunto del servicio de pediatría. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Tortosa Burgos Francisco. Comandante médico estomatólogo. Aptitud AB. El Puerto de Santa María. Cádiz. Valdeón Arévalo Francisco José. Comandante médico. Adjunto del servicio de otorrinolaringología. Hospital General de la Defensa « San Carlos». San Fernando (Cádiz). Vaz Pardal Carmen. Médico del deporte. Centro Andaluz de Medicina del Deporte. San Fernando (Cádiz). 4 A la memoria del médico de la Armada Antonio de Lara Muñoz-Delgado (1929-2003), pionero y maestro de la Medicina Subacuática en España, que creyó cuando nadie creía, que creó donde nada había. Cuando buceo, el agua es clara y azul. Me siento seguro, no tengo miedo. A unas treinta metros de profundidad pierdo de vista la superficie. Me encuentro solo en un entorno azul oscuro en el que difícilmente distingo el fondo. Luego lo descubro y me siento a salvo. Hay una relativa claridad porque la luz se refleja. Jacques-Yves Cousteau. Entrevista con Perry Miller publicada en Life, 27 noviembre de 1950. En: Violet B. Cousteau. Un hombre del mar. Madrid: Temas de Hoy SA, 1993; p.127. 5 PREFACIO EDITORES La provincia de Cádiz dispone de más de 100 kilómetros de costas y playas. La práctica del buceo deportivo se ha incrementado en los últimos años, con la aparición de numerosos clubes y deportistas federados. Ello, unido a los periódicos ejercicios de buceo militar de la Marina española (Núcleo de Buceo de Puntales y Base Naval de Rota), americana (Rota) e inglesa (Gibraltar), junto a las maniobras de la OTAN, incrementan el riesgo de aparición de accidentes subacuáticos. El Hospital General de la Defensa «San Carlos» en San Fernando (Cádiz), es el único público de Andalucía que dispone de unas instalaciones capaces de asumir el tratamiento de los accidentes de buceo y de las patologías subsidiarias de oxígeno a presión. Su servicio de Medicina Subacuática e Hiperbárica (en funcionamiento desde mayo de 2001) es el de referencia para cualquier evento subacuático que ocurra en el litoral, desde Ayamonte hasta Gibraltar, incluyendo militares estadounidenses e ingleses. En este año 2007 se cumplen siete ediciones del Curso del Doctorado sobre Medicina Subacuática e Hiperbárica que, en colaboración con la Universidad de Cádiz, se han desarrollado en nuestro hospital. Este lapso de tiempo es apropiado para el sedimento de unos conocimientos en una disciplina poco conocida, tanto en el ámbito académico universitario como en el público en general, y así se ha decidido publicar un manual en el que se recojan las lecciones impartidas a lo largo de estos años. El objetivo del mismo ha sido su distribución a los alumnos, a los servicios de urgencias hospitalarios y extra-hospitalarios de nuestra comunidad autónoma, y a los servicios clínicos que puedan precisar tratamientos hiperbáricos para sus pacientes, con objeto de difundir esta modalidad terapéutica. Se ha pretendido que los temas estén actualizados y tengan una orientación práctica para los facultativos poco habituados al manejo de estas patologías. Los autores, con una participación totalmente altruista, han sido los profesores de las anteriores ediciones del curso. En este manual se plasma el esfuerzo de un grupo de facultativos y enfermeros que tras una encomiable y desinteresada colaboración han reflejado en muchos casos vivencias personales a lo largo de sus años de experiencia profesional. El reducido mundo de la Medicina Subacuática e Hiperbárica ha condicionado que los que la ejercitan, a base de un continuado contacto, hayan llegado a ser un grupo de amigos con motivaciones comunes. A todos ellos, a la dirección del hospital, a la Universidad de Cádiz, al Club de Buceo Deportivo «Escafandra» del CN Elcano y finalmente al Laboratorio Salvat, patrocinador y divulgador del manual, nuestro más sincero agradecimiento. El comité editor 6 ABREVIATURAS (Illera Martín M. Diccionario de acrónimos con símbolos y abreviaturas para las ciencias de la salud. Madrid: Fundación Wellcome España, 1994) AAP: antiagregante plaquetario AAS: ácido acetil salicílico AB: accidentes de buceo a.C: antes de Cristo AINE: anti-inflamatorio no esteroide Atm: atmósferas ATA: atmósferas absolutas bd: dos veces al día BHE: barrera hematoencefálica BOE: Boletín Oficial del Estado BT: barotraumatismos CAE: conducto auditivo externo CAI: conducto auditivo interno CBA: Centro de Buceo de la Armada CBD: Club de Buceo Deportivo CCCMH: Comité Coordinador de Centros de Medicina Hiperbárica CH: cámara hiperbárica CHH: centro hiperbárico hospitalario CID: coagulación intravascular diseminada cm: centímetro CN: club náutico CO: monóxido de carbono CO 2: anhídrido carbónico COHb: carboxihemoglobina CPAP: presión positiva continua en vías respiratorias CPT: capacidad pulmonar total CRIS-UTH: Centro de Recuperación e Investigaciones Submarinas–Unidad de Terapéutica Hiperbárica. Hospital de la Cruz Roja. Barcelona D: día dB: decibelio DLCO: factor de transferencia de monóxido de carbono ECC: Segunda Conferencia Europea de Consenso en Medicina Hiperbárica ED: enfermedad descompresiva FR: frecuencia respiratoria fsw: pies de agua de mar ft: pies FiO 2: fracción inspirada de oxigeno g: gramo h: hora Hb: hemoglobina Hct: hematocrito IV: intravenoso kg: kilogramo km: kilómetro l: litro LCR: líquido cefalorraquídeo m: metros m3: metro cúbico mg: miligramo min: minuto ml: mililitro mmHg: milímetro de mercurio 7 msw: metros de agua de mar N2: nitrógeno OE: otitis externa OHB: oxigenoterapia hiperbárica OI: oído interno OM: oído medio ONB: oxígeno normobárico O2: oxígeno P: presión Pa: presión absoluta PaO 2: presión arterial de oxígeno PA O2 : presión alveolar de oxígeno
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