DOCSLIB.ORG

Diving-Related Otological Injuries

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diving-Related Otological Injuries CLINICAL Diving-related otological injuries Initial assessment and management Lyndon Nofz, Jemma Porrett, Nathan Yii, SCUBA DIVING, during which a diver uses pressure increases by 1 atm. For most Nadine De Alwis a self-contained underwater breathing purposes, atmospheric gas is made up of apparatus (scuba), is a popular recreational 21% oxygen and 79% nitrogen, similar to activity resulting in frequent presentations compressed gases found in a scuba tank. Background Scuba diving–related otological injuries to the general practitioner (GP). Two important laws of physics govern comprise the majority of diving-related Incorrect diagnosis and management the physiology associated with pressure incidents that present to general of otological diving injuries can lead to changes during scuba diving. Boyle’s practitioners (GPs). Correct diagnosis significant morbidity including chronic Law (P1V1 = P2V2) dictates that the and management are key to prevent vestibulopathy and hearing loss. As pressure and volume of a gas at a constant permanent hearing loss and vertigo. many patients present to the GP with temperature are inversely proportional. Objective diving-related concerns, it is pertinent As the diver descends, ambient pressure The aim of this article is to increase that treating clinicians are aware of the increases. The middle ear, being an awareness of the pathophysiology of common presentations, initial treatment air-filled space, correspondingly reduces its otological diving injuries and provide and prevention of such injuries. volume by 50% in the first 10 m of descent an approach to initial assessment and (Figure 1). If equalisation does not occur, treatment, as well as to highlight particular circumstances in which then a vacuum is created, placing pressure onward referral is required. Epidemiology on the tympanic membrane and round Diving-related otological injuries and oval windows (the flexible walls of this Discussion account for 65–72% of all diving- space). This accounts for direct pressure– Accurate diagnosis and treatment of related presentations to practitioners.1,2 related ear injuries during diving. diving-related otological injuries by GPs can have profound positive effects on a Middle ear barotrauma (MEB) is most As ambient pressure increases, so does patient’s long-term outcomes. Complete common, accounting for nearly 50% the partial pressure of each of the gases otolaryngological assessment in those of presentations.2 Decompression within the environment. Henry’s Law who have previously had a dive-related sickness (DCS) is one of the most severe dictates that as the partial pressure of a injury is critical to ensure patient safety diving-related complications and has gas increases, a greater amount becomes prior to recommencing scuba diving. an Australian incidence rate of 10 per dissolved in surrounding liquids. During 100,000 dives.3 Inner ear DCS (IEDCS) uncontrolled ascent, the reduction in is rare, with an estimated recreational pressure causes release of dissolved gas diving incidence rate of 0.01–0.03%.4 nitrogen bubbles within tissues or blood that can lead to cell injury and hypoxia, causing the symptoms of DCS. Pathophysiology – A lesson in physics Otological diving injuries occur as a External ear pathology result of the effect of ambient pressure Otitis externa changes on the ear structures. At sea Otitis externa is common among those level the atmospheric pressure is who spend considerable amounts of 1 atmosphere (atm). For every 10 m a diver time submerged underwater. Prolonged descends below this level, the ambient exposure of the ears to water results 500 | REPRINTED FROM AJGP VOL. 49, NO. 8, AUGUST 2020 © The Royal Australian College of General Practitioners 2020 DIVING-RELATED OTOLOGICAL INJURIES CLINICAL in a change in canal pH and skin volumes decrease, creating a vacuum. Symptoms include dullness or pain maceration, damaging the primary Serous or haemorrhagic effusion and in the ear and hearing loss. Tympanic skin barrier and promoting infection.5 tympanic membrane rupture can result membrane perforation during a dive Pseudomonas aeruginosa is the organism secondary to the negative pressure.10 can cause severe vertigo from caloric most responsible for acute otitis externa Conversely, during ascent, middle ear stimulation of cold water in the middle ear. following diving.6 The principles of volume expands as pressure decreases. If nausea and vomiting ensues, this can be treatment remain the same as for Normally this is passively released fatal because of obligate mouth breathing non-divers, with dry ear precautions, aural through a functional eustachian tube. during scuba diving.11 MEB can be graded toilet and topical antimicrobial therapy. However, with ETD, volume expansion using the modified Teed classification,12 can create bulging of the tympanic which is useful in guiding flying and diving Exostoses membrane and perforation. restrictions post-injury (Table 1). Exostoses are bony outgrowths of the medial ear canal. They commonly occur in divers in response to chronic cold water or wind exposure that triggers refrigeration periosteitis.7 Bony canal stenosis can result in water and wax retention, predisposing to otitis externa. When severe, complete occlusion of the canal results in a conductive hearing loss. Furthermore, unilateral occlusion can lead to an asymmetric caloric stimulus underwater, leading to vertigo.8 Promoting the use of appropriately fitted wetsuit hoods can help to prevent this progression. Referral to an otolaryngologist for consideration of a canalplasty may be necessary in severe or symptomatic cases. External canal barotrauma External canal barotrauma can occur as a result of occlusion of the ear canal by exostoses, impacted cerumen and tight wetsuit hoods. An air-filled space between the occlusion and tympanic membrane is created, and negative pressure is Figure 1. Boyle’s law dictates that as pressure increases below the water surface, the volume generated on descent, leading to swelling of closed spaces decreases. and haemorrhagic blistering of the canal wall. Treatment consists of analgesia and topical steroid ear drops.9 External canal barotrauma can be reduced by avoiding Table 1. Modified Teed classification12 for middle ear barotrauma* tightly fitted hoods and cotton bud use for Grading Otoscopic findings Estimated return to dive wax removal. Aural toilet is recommended for persistent wax impaction. Grade 0 Normal tympanic membrane Seven to 10 days (complete resolution) Grade 1 Tympanic membrane erythematous/ inflamed Middle ear pathology Grade 3 Gross haemorrhage of the tympanic Six weeks (blood reabsorption) Middle ear barotrauma membrane MEB occurs when the diver cannot or does not regularly equalise on descent or Grade 4 Extensive free blood in middle ear ascent. This may be due to inexperience with bubbles visible behind tympanic membrane (haemotympanum) or eustachian tube dysfunction (ETD) secondary to rhinosinusitis, allergy or Grade 5 Perforation of the tympanic membrane Three months (healed perforation) nasopharyngeal obstruction. As external *Grade 2 has not been included in this modification pressures rise on descent, middle ear © The Royal Australian College of General Practitioners 2020 REPRINTED FROM AJGP VOL. 49, NO. 8, AUGUST 2020 | 501 CLINICAL DIVING-RELATED OTOLOGICAL INJURIES Management involves exclusion of inner present with vertigo, nausea and vomiting, is also not recommended within 24 hours ear barotrauma, short-term use of nasal although hearing loss and other central following diving.13 The use of oral or topical decongestants and/or intranasal steroid nervous system symptoms frequently decongestants is discouraged to treat ETD or sprays and antibiotics for any secondary occur.19 Examination usually reveals sinusitis prior to diving as their effects may infection.11 Diving should not recommence a normal external canal and tympanic wear off while underwater, leaving the diver until all symptoms have resolved, tympanic membrane. Tuning forks may reveal SNHL, in danger.13 membrane perforations have healed and nystagmus is usually present. Fitness to return to diving depends on and equalisation is possible. In cases of It is important for inner ear DCS to be residual symptoms and ongoing pathology. persistent tympanic membrane perforation, differentiated from inner ear barotrauma as Persisting neurology, especially affecting surgical repair may be necessary. treatment is markedly different (Table 2).20 the vestibular system, is associated with Treatment of inner ear DCS includes early high risk. An estimated 90% of patients recompression with hyperbaric oxygen, with previous diving-related vestibular Inner ear pathology preferably within five hours of symptom dysfunction have ongoing long-term Inner ear barotrauma onset. In the general practice setting, it deficits necessitating thorough assessment Rupture of the round or oval windows is recommended that administration of prior to continuing scuba diving.18 Some creates a perilymphatic fistula (PLF), 100% oxygen and intravenous saline or authors recommend full vestibulocochlear which can cause sensorineural hearing oral fluids be provided. Urgent referral assessment and exclusion of a right-to-left loss (SNHL), vertigo and tinnitus. Two to the nearest centre with a hyperbaric vascular shunt in those who have previously mechanisms have been postulated chamber is critical to long-term prognosis.4 had inner ear DCS.6,18 (Figure 2).13,14 If there is doubt regarding whether the Return
Load more

Recommended publications
  • The Use of Heliox in Treating Decompression Illness
    The Diving Medical Advisory Committee DMAC, Eighth Floor, 52 Grosvenor Gardens, London SW1W 0AU, UK www.dmac-diving.org Tel: +44 (0) 20 7824 5520 [email protected] The Use of Heliox in Treating Decompression Illness DMAC 23 Rev. 1 – June 2014 Supersedes DMAC 23, which is now withdrawn There are many ways of treating decompression illness (DCI) at increased pressure. In the past 20 years, much has been published on the use of oxygen and helium/oxygen mixtures at different depths. There is, however, a paucity of carefully designed scientific studies. Most information is available from mathematical models, animal experiments and case reports. During a therapeutic compression, the use of a different inert gas from that breathed during the dive may facilitate bubble resolution. Gas diffusivity and solubility in blood and tissue is expected to play a complex role in bubble growth and shrinkage. Mathematical models, supported by some animal studies, suggest that breathing a heliox gas mixture during recompression could be beneficial for nitrogen elimination after air dives. In humans, diving to 50 msw, with air or nitrox, almost all cases of DCI can be adequately treated at 2.8 bar (18 msw), where 100% oxygen is both safe and effective. Serious neurological and vestibular DCI with only partial improvements during initial compression at 18 msw on oxygen may benefit from further recompression to 30 msw with heliox 50:50 (Comex therapeutic table 30 – CX30). There have been cases successfully treated on 50:50 heliox (CX30), on the US Navy recompression tables with 80:20 and 60:40 heliox (USN treatment table 6A) instead of air and in heliox saturation.
    [Show full text]
  • Dysbarism - Barotrauma
    DYSBARISM - BAROTRAUMA Introduction Dysbarism is the term given to medical complications of exposure to gases at higher than normal atmospheric pressure. It includes barotrauma, decompression illness and nitrogen narcosis. Barotrauma occurs as a consequence of excessive expansion or contraction of gas within enclosed body cavities. Barotrauma principally affects the: 1. Lungs (most importantly): Lung barotrauma may result in: ● Gas embolism ● Pneumomediastinum ● Pneumothorax. 2. Eyes 3. Middle / Inner ear 4. Sinuses 5. Teeth / mandible 6. GIT (rarely) Any illness that develops during or post div.ing must be considered to be diving- related until proven otherwise. Any patient with neurological symptoms in particular needs urgent referral to a specialist in hyperbaric medicine. See also separate document on Dysbarism - Decompression Illness (in Environmental folder). Terminology The term dysbarism encompasses: ● Decompression illness And ● Barotrauma And ● Nitrogen narcosis Decompression illness (DCI) includes: 1. Decompression sickness (DCS) (or in lay terms, the “bends”): ● Type I DCS: ♥ Involves the joints or skin only ● Type II DCS: ♥ Involves all other pain, neurological injury, vestibular and pulmonary symptoms. 2. Arterial gas embolism (AGE): ● Due to pulmonary barotrauma releasing air into the circulation. Epidemiology Diving is generally a safe undertaking. Serious decompression incidents occur approximately only in 1 in 10,000 dives. However, because of high participation rates, there are about 200 - 300 cases of significant decompression illness requiring treatment in Australia each year. It is estimated that 10 times this number of divers experience less severe illness after diving. Physics Boyle’s Law: The air pressure at sea level is 1 atmosphere absolute (ATA). Alternative units used for 1 ATA include: ● 101.3 kPa (SI units) ● 1.013 Bar ● 10 meters of sea water (MSW) ● 760 mm of mercury (mm Hg) ● 14.7 pounds per square inch (PSI) For every 10 meters a diver descends in seawater, the pressure increases by 1 ATA.
    [Show full text]
  • Hyperbaric Oxygen Therapy for Decompression Illness/Gas Embolism (All Ages)
    Clinical commissioning policy: Hyperbaric oxygen therapy for decompression illness/gas embolism (all ages) For implementation from 1 April 2019 NHS England Reference: 170047P NHS England INFORMATION READER BOX Directorate Medical Operations and Information Specialised Commissioning Nursing Trans. & Corp. Ops. Commissioning Strategy Finance Publications Gateway Reference: 07603 Document Purpose Policy Clinical commissioning policy: Hyperbaric oxygen therapy for Document Name decompression illness/gas embolism (all ages) Author Specialised Commissioning Team Publication Date 20 July 2018 Target Audience CCG Clinical Leaders, Care Trust CEs, Foundation Trust CEs , Medical Directors, Directors of PH, Directors of Nursing, NHS England Regional Directors, NHS England Directors of Commissioning Operations, Directors of Finance, NHS Trust CEs Additional Circulation #VALUE! List Description Routinely Commissioned - NHS England will routinely commission this specialised treatment in accordance with the criteria described in this policy. Cross Reference 0 Superseded Docs 0 (if applicable) Action Required 0 Timing / Deadlines By 00 January 1900 (if applicable) Contact Details for [email protected] further information 0 0 0 0 0 0 Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. 2 For implementation from 1 April 2019 Standard Operating Procedure: Clinical Commissioning Policy: Hyperbaric oxygen therapy for decompression illness/gas embolism (all ages) First published: July 2018 Prepared by NHS England Specialised Services Clinical Reference Group for Hyperbaric oxygen therapy Published by NHS England, in electronic format only.
    [Show full text]
  • Biomechanics of Safe Ascents Workshop
    PROCEEDINGS OF BIOMECHANICS OF SAFE ASCENTS WORKSHOP — 10 ft E 30 ft TIME AMERICAN ACADEMY OF UNDERWATER SCIENCES September 25 - 27, 1989 Woods Hole, Massachusetts Proceedings of the AAUS Biomechanics of Safe Ascents Workshop Michael A. Lang and Glen H. Egstrom, (Editors) Copyright © 1990 by AMERICAN ACADEMY OF UNDERWATER SCIENCES 947 Newhall Street Costa Mesa, CA 92627 All Rights Reserved No part of this book may be reproduced in any form by photostat, microfilm, or any other means, without written permission from the publishers Copies of these Proceedings can be purchased from AAUS at the above address This workshop was sponsored in part by the National Oceanic and Atmospheric Administration (NOAA), Department of Commerce, under grant number 40AANR902932, through the Office of Undersea Research, and in part by the Diving Equipment Manufacturers Association (DEMA), and in part by the American Academy of Underwater Sciences (AAUS). The U.S. Government is authorized to produce and distribute reprints for governmental purposes notwithstanding the copyright notation that appears above. Opinions presented at the Workshop and in the Proceedings are those of the contributors, and do not necessarily reflect those of the American Academy of Underwater Sciences PROCEEDINGS OF THE AMERICAN ACADEMY OF UNDERWATER SCIENCES BIOMECHANICS OF SAFE ASCENTS WORKSHOP WHOI/MBL Woods Hole, Massachusetts September 25 - 27, 1989 MICHAEL A. LANG GLEN H. EGSTROM Editors American Academy of Underwater Sciences 947 Newhall Street, Costa Mesa, California 92627 U.S.A. An American Academy of Underwater Sciences Diving Safety Publication AAUSDSP-BSA-01-90 CONTENTS Preface i About AAUS ii Executive Summary iii Acknowledgments v Session 1: Introductory Session Welcoming address - Michael A.
    [Show full text]
  • Stiddmil.Com POWER POD RNAV2 SIMULATOR
    DPD2 • RNAV2 • AP2 • OM2 • AC2 • POWER POD • CP2 CATALOG 22 POWER POD NEW! RNAV2 SIMULATOR Manned & Autonomous Vehicles with Navigation, Control & Communications for EOD and Maritime SOF stiddmil.com MADE IN U.S.A. Manned or Autonomous... The “All-In-One” Vehicle Moving easily between manned and autonomous roles, STIDD’s new generation of propulsion vehicles provide operators innovative options for an increasingly complex underwater environment. Over the past 20 years, STIDD built its Submersible line and flagship product, the Diver Propulsion Device (DPD), around the basic idea that divers would prefer riding a vehicle instead of swimming. Today, STIDD focuses on another simple, but transformative goal: design, develop, and integrate the most advanced Precision Navigation, Control, Communications, and Automation Technology available into the DPD to make that ride easier, more effective, and when desired . RIDERLESS! DPD2 - Manned Mode 1 DPD2 - OM2 Mode Precision Navigation, Control, Communications & Automation System for the DPD POWERED BY RNAV2 GREENSEA Building on the legacy of its Diver Propulsion Device (DPD), the most widely used combat vehicle of its kind, STIDD designed and developed a system of DPD Navigation, Control, Communications, and Automation features which enable a seamless transition between Manned and fully Autonomous modes. RNAV2 was developed by STIDD partnering with Greensea as the backbone of this capability. RNAV2 is powered by Greensea’s patent-pending OPENSEA™ operating platform, which not only enables RNAV2’s open architecture, but also seamlessly integrates STIDD’s OM2/AP2 Diver Assist /S2 Sonar/ AC2 Communications products into an intuitive, easy to use, autonomous system. When fully configured with the Precision Navigation, Control & Automation System including RNAV2/ OM2/AP2/S2/AC2, any DPD easily transitions between Manned, DPD with RNAV2 Installed Semi-Autonomous, and Full-Autonomous modes.
    [Show full text]
  • Atmos Elite Owner's Guide, Doc
    OR ATMOS ELITE DIVE COMPUTER OWNER'S GUIDE LIMITED TWO-YEAR WARRANTY For details, refer to the Product Warranty Registration Card provided. COPYRIGHT NOTICE This owners guide is copyrighted, all rights are reserved. It may not, in whole or in part, be copied, photocopied, reproduced, translated, or reduced to any electronic medium or machine readable form without prior consent in writ- ing from AERIS / 2002 Design. Atmos Elite Owner's Guide, Doc. No. 12-7156 © 2002 Design 2003 San Leandro, Ca. USA 94577 TRADEMARK NOTICE AERIS, the AERIS logo, Atmos Elite, and the Atmos Elite logo are all registered and unregistered trademarks of AERIS. All rights are reserved. PATENT NOTICE U.S. Patents have been issued, or applied for, to protect the following design features: Dive Time Remaining (U.S. Patent no. 4,586,136), Data Sensing and Processing Device (U.S. Patent no. 4,882,678), and Ascent Rate Indicator (U.S. Patent no. 5,156,055). User Setable Display (U.S. Patent no. 5,845,235) is owned by Suunto Oy (Finland). DECOMPRESSION MODEL The programs within the Atmos Elite simulate the absorption of nitrogen into the body by using a mathematical model. This model is merely a way to apply a limited set of data to a large range of experiences. The Atmos Elite dive computer model is based upon the latest research and experiments in decompression theory. Still, using the Atmos Elite, just as using the U.S. Navy (or other) No Decompression Tables, is no guarantee of avoiding decompression sickness, i.e. the bends. Every divers physiology is different, and can even vary from day to day.
    [Show full text]
  • The Effects of Warm and Cold Water Scuba Finning on Cardiorespiratory Responses and Energy Expenditure
    AN ABSTRACT OF THE THESISOF in Caron Lee Louise Shake for the degreeof Doctor of Philosophy Education presented on April 5, 1989. Scuba Finning on Title: The Effects of Warm and Cold Water Cardiorespiratory Responses and EnergyExpenditure Redacted for privacy Abstract approved: cardiorespiratory and energy This study was designed to determine finning at expenditure responses elicited byrecreational divers while and warm (29°C) water a submaximal intensity(35% max) in cold (18°C) to par- with and without wet suits. Male divers (15) volunteered exercise ticipate in five experimentalprocedures. A maximal graded in 29°C tethered finning test, two submaximal(30 min.) finning tests tests with and without wet suits, and twosubmaximal (30 min.) finning The variables in 18°C with and without wetsuits were performed. (VE), measured were: breathing frequency(BF), minute ventilation (RER), heart rate oxygen consumption (V02)respiratory exchange ratio (HR), and core temperature (CT). Caloric expenditure (kcal) was calculated from RER and V02. A Four-Way ANOVA andrepeated measures 0.05) Two-Way design was used to analyze the data. A significant (p < A significant (p < (suit x time) interaction wasrevealed for BF. 0.01) Three-Way (suit x temp. x time)interaction was revealed forVE, V02, RER, HR, and CT. An inverse relationship exists betweenBF and VE when comparing dives with and without suits. Diving in 18°C with suitselicited higher BF and lower VE than diving in 29°Cwithout suits. V02 increased significantly during threeof the four dives. Diving without suits elicited higher V02values though this was not significant in every case. Diving in a cold environmentelicited lower RER re- higher V02 and VE.
    [Show full text]
  • FIU-DOM-01 Revision-1 12/2019 10
    FIU-DOM-01 Revision -1 12/2019 1 11200 SW 8th Street, Miami Florida, 33199 http://www.fiu.edu TABLE of CONTENTS Section 1.00 GENERAL POLICY 6 1.10 Diving Standards 6 1.20 Operational Control 7 1.30 Consequence of Violation of Regulations by divers 9 1.40 Job Safety Analysis 9 1.50 Dive Team Briefing 10 1.60 Record Maintenance 10 Section 2.00 MEDICAL STANDARDS 11 2.10 Medical Requirements 11 2.20 Frequency of Medical Evaluations 11 2.30 Information Provided Examining Physician 11 2.40 Content of Medical Evaluations 11 2.50 Conditions Which May Disqualify Candidates from Diving (Adapted from Bove, 1998) 11 2.60 Laboratory Requirements for Diving Medical Evaluation and Intervals 12 2.70 Physician's Written Report 13 Section 3.00 ENTRY-LEVEL REQUIRMENTS 14 3.10 General Policy 14 Section 4.00 DIVER QUALIFICATION 14 4.10 Prerequisites 14 4.20 Training 15 4.30 FIU Working Diver Qualification 18 4.40 External (Non-FIU Employee) Diver Qualifications 18 4.50 Depth Certifications 22 4.60 Continuation of FIU Working Diver Certification 22 4.70 Revocation of Certification or Designation 23 4.80 Requalification After Revocation of Diving Privileges 23 4.90 Guest Diver 23 Section 5.00 DIVING REGULATIONS FOR SCUBA (OPEN CIRCUIT, COMPRESSED AIR) 24 5.10 Introduction 24 5.20 Pre-Dive Procedures 24 5.30 Diving Procedures 25 5.40 Post-Dive Procedures 30 5.50 Emergency Procedures 30 5.60 Flying After Diving or Ascending to Altitude (Over 1000 feet) 30 5.70 Record Keeping Requirements 30 FIU-DOM-01 Revision-1 12/2019 2 Section 6.00 SCUBA DIVING EQUIPMENT 32
    [Show full text]
  • Finned Pilot Whales Reduce Sound Exposure from Naval Sonar?
    *ManuscriptView metadata, citation and similar papers at core.ac.uk brought to you by CORE Click here to view linked References provided by St Andrews Research Repository 1 2 3 How effectively do horizontal and vertical response strategies of long- 4 finned pilot whales reduce sound exposure from naval sonar? 5 6 7 Paul J. Wensveena,b, Alexander M. von Benda-Beckmannb, Michael A. Ainslieb, 8 Frans-Peter A. Lamb, Petter H. Kvadsheimc, Peter L. Tyacka, and Patrick J. O. 9 Millera 10 aSea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St 11 Andrews, Fife, KY16 8LB, United Kingdom 12 bAcoustics & Sonar Research Group, Netherlands Organisation for Applied Scientific 13 Research (TNO), PO Box 96864, The Hague, 2509 JG, The Netherlands 14 cMaritime Systems, Norwegian Defence Research Establishment (FFI), NO-3191, Horten, 15 Norway 16 17 18 Corresponding author: P. J. Wensveen. Tel.: +44 1334 46 3607; Email address: pw234@st- 19 andrews.ac.uk 20 21 22 23 1 24 Abstract 25 The behaviour of a marine mammal near a noise source can modulate the sound exposure it 26 receives. We demonstrate that two long-finned pilot whales surfaced in synchrony with 27 consecutive arrivals of multiple sonar pulses. We then assess the effect of surfacing and other 28 behavioural response strategies on the received cumulative sound exposure levels and 29 maximum sound pressure levels (SPLs) by modelling realistic spatiotemporal interactions of 30 a pilot whale with an approaching source. Under the propagation conditions of our model, 31 some response strategies observed in the wild were effective in reducing received levels (e.g.
    [Show full text]
  • Delayed Treatment of Decompression Sickness with Short, No-Air-Break Tables: Review of 140 Cases
    REVIEW ARTICLE Delayed Treatment of Decompression Sickness with Short, No-Air-Break Tables: Review of 140 Cases Paul Cianci and John B. Slade,Jr. CIANCI P, SLADE JR JB. Delayed treatment of decompression sick- increasing frequency, often having dived very provoc- ness with short, no-air-break tables: review of 140 cases. Aviat Space ative profiles, many suffering from severe DCS, and Environ Med 2006; 77:1003–8. Introduction: Most cases of decompression sickness (DCS) in the U.S. with long delays to treatment. are treated with hyperbaric oxygen using U.S. Navy Treatment Tables 5 In 1963 and 1964, the Navy Experimental Dive Unit and 6, although detailed analysis shows that those tables were based on received reports of 133 cases of DCS in which the stan- limited data. We reviewed the development of these protocols and offer dard USN tables at the time were used (28). Full relief an alternative treatment table more suitable for monoplace chambers did not result in 24% of initial recompressions. When that has proven effective in the treatment of DCS in patients presenting to our facility. Methods: We reviewed the outcomes for 140 cases of outcomes using USN Tables 3 and 4 were analyzed, a DCS in civilian divers treated with the shorter tables at our facility from 47% incidence of failure of the first treatment was January 1983 through December 2002. Results: Onset of symptoms noted. However, there were no instances of treatment averaged 9.3 h after surfacing. At presentation, 44% of the patients failure when DCS had occurred following rigid USN demonstrated mental aberration.
    [Show full text]
  • Mares Buyer's Guide
    buyer’s guide MISSION / INTRO COMPANY / PROFILE HOW TO READ In 1949, Ludovico Mares designed and manufactured his first masks and Would Ludovico Mares ever have imagined that over the course of 68 years The 2017 Mares catalog contains all of Mares’ products: a complete collection of the latest equipment, filled with innovative product features, spearguns with one purpose in mind: to share his extreme passion for his small factory in Rapallo would become the worldwide leader in the pro- designed to meet and satisfy the needs and dreams of every individual diver. the sea and diving with the rest of the world. At the beginning, Mares was duction and distribution of diving equipment? This catalogue has been developed specifically to help you the dealer make the best choices when selecting which products and technologies will just a small factory in Rapallo; today, more than 68 years later, the Italian Mares was founded in 1949 by former Istrian diver Ludovico Mares, who best fulfill your customer’s needs. based company dominates the scuba diving world with leading design served in the Austrian Navy during World War I. and technology. Over the past six decades, Mares has come a long way by Mares quickly became a small industrial company with a continuous in- Keep on reading and enjoy the new 2017 Mares Collection. achieving new goals and taking diving to new extreme heights and depths. crease in sales and never an absence of ideas for new and improved Mares represents only the best in dive products. products. As the passion for diving grew around the world in the late ‘60s, Over the past 68 years, Mares has become the worldwide leader in the company expanded into the European diving and snorkeling market.
    [Show full text]
  • Decompression Illness
    Decompression Illness DCI • Decompression illness (DCI) includes DCS and • Diagnosis – generally hx, estimation of AGE likelihood • ~1-10/10,000 dives • Sx depend on location of insult • Higher in cold water, deep; lower in recreational • <24 hrs possible, >24 hrs unlikely, >36 hrs warm water diving (1-4/10k) very unlikely, >48 hrs almost impossible • Traditional/Golding Classification unless altitude change • Type I (MSK, skin, lymph, fatigue) • There is no pathognomonic test for DCI • Type II (neuro, cardio-resp, ENT, shock) • AGE • Tx 100% Surface O2 • Descriptive/Francis Smith Class • • Evolution (spontaneous recovery, static, relapsing) • IVF • Progressive (increasing #, severity of s/sx) • Evacuation considerations • Organ System • Airway, foley, pressurized cabin or as low as • Neuro, cardio-pulm, MSK, skin, lymph, ENT possible • Time of onset (before or after surfacing) • HBOT • Gas burden • Low (conservative within NoD), Med (D Dive), High (violation dive table) • Evidence of barotrauma DCS Pathophysiology • Henry’s Law – amount of inert gas • Inflammatory & thrombogenic absorbed by blood/tissue increased at processes depth • Association with oxidative stress, microparticles • Boyle’s Law P1V1= P2V2 • Bubbles biologically active – form • Bubble effects plasma-protein coat activating WBC, plts, • Intravascular - embolism, vasospasm, fibrin web ischemia, transbolism, venous stasis, • “Thick skin” stabilizes bubble, decreases hemorrhage, blood-bubble interactions, diffusion of inert gas out of bubble mechanical stripping of endothelial
    [Show full text]