DOCSLIB.ORG

WS17 Deep: Scuba Diving Associated Risks and Complications

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
WS17 Deep: Scuba Diving Associated Risks and Complications Disclosures • I have no financial conflicts of interest Deep: Scuba diving associated • I am a US government Employee, Risks and Complications however this lecture represents my Kyle Petersen, DO, FACP, FIDSA professional opinions and not official Director of Epidemiology & Surveillance policy of the US Government nor the Peace Corps, Peace Corps –1 –2 Introduction Objectives • 1-3 Million scuba divers in USA2 1 • Know fitness for diving • ~$500 Million/year industry in USA • 1 million scuba divers in EU2 • Know aspects and clinical symptoms of • 3-9/100,000 deaths in US alone(60% Drowning)2 Barotrauma • Tropical destinations common • Know clinical presentation of POIS • Know clinical presentations of Decompression Sickness (DCS) • Miscellaneous: Malaria, Altitude etc. 1http://www.prweb.com/releases/2012/1/prweb9093526.htm 2 Keystone Travel Med 2nd edition –3 –4 Belize, Roatan, Cozumel, Cayman Egypt, Jordan, Oman Islands, Bonaire, Case Venezuela, Bahamas • A 45 y/o lawyer presents to your office for pre-travel visit. He is going to Bonaire in the Caribbean. In addition to food and water hygiene counseling and Hep A vaccine he asks you to complete his Scuba physical exam form, he has a history of patent foramen ovale. Galapagos, Ecuador Australia, Indonesia • A: fill out the form Cocos Island, Costa Kenya, Mozambique, Micronesia • B: charge extra and fill out the form Rica Seychelles, Maldives, Fiji • C: refer to a diving medicine physician Thailand, Malaysia French Polynesia –5 –6 1 Medications Fitness to dive • Contraindicated- • Should be done by a certified diving physician – Narcotics, antipsychotics, Anti-convulsants • Age, Sex, Training – Beta blockers or vasodilators if recently started • Contraindications: Absolute (Seizures, Active cardiac disease, active psychiatric disease, SCD, • Relatively safe Chronic lung diseases, perforated TM, hernias, – NSAIDS, acetaminophen, Digoxin, Antibiotics, orthopedic injury) decongestants, antihistamines, scopolamine, • Contraindications: Relative (Asthma, DMII, Migraines, recent eye surgery, URI, pregnancy) meclizine • PFO controversial: 20% of population; 40% DCS cases –7 –8 • A 28 y/o female presents to your office after returning from Sulawesi Indonesia. She had a bad URI but traveled anyway, she went diving since she had invested so much in trip. After one dive she felt pressure in her L ear then a loud noise and felt slightly dizzy. Now “it sounds like I’m under a pillow when people talk” she stopped diving for the last 2 days. •This is • A: Barotrauma sinus squeeze • B: BarotraumaTM rupture • C: Barotrauma Oval window rupture • D: DCS (The bends) •E: Arterial Gas Embolism –9 –10 BAROTRAUMA BAROTRAUMA • Injury caused by changes in pressure • Boyle’s Law (Pressure inversely • SQUEEZE proportional to Volume P=1/V) • barotrauma of •“Ingredients” descent – rigid walls • 10m=1 ATM – gas filled space • damage from – enclosed space relative vacuum – ambient pressure change • 100% Preventable by not diving when abnormal anatomical conditions exist –11 –12 2 BAROTRAUMA BAROTRAUMA • REVERSE SQUEEZE • EXTERNAL EAR – barotrauma of ascent – Predisposing Factors – damage from expanding gases • obstruction of the external canal by wax • tight wet suit hood •ear plugs • otitis externa • Usually leads to reverse squeeze –13 –14 • BAROTRAUMA • MIDDLE EAR “MOST COMMON” – Etiology: blocked Eustachian tube – Predisposing Factors •infections (URI) • allergies (Hay Fever) • anatomic variations • inability to equalize pressure • Usually leads to ear squeeze –15 –16 BAROTRAUMA BAROTRAUMA • EAR SQUEEZE • CLINICAL MANAGEMENT – Clinical Manifestations: –Treatment • mild: injected TM • no diving until re-evaluated • moderate: intratympanic hemorrhage • decongestants i.e. Sudafed, Afrin • severe: hemorrhage behind TM with or w/o perforation • If perforated consider ENT referral – If perforation occur, rush of cold water into inner ear can cause vestibular symptoms (caloric vertigo) and ultimately infection –17 –18 3 BAROTRAUMA BAROTRAUMA • INNER EAR INJURY • INNER EAR – Clinical Manifestations • fullness of middle ear on – implosive or explosive injury descent • forceful Valsalva or – round window rupture severe ear squeeze • audible “pop” – oval window rupture • sudden onset of roaring tinnitus – intracochlear membrane rupture • sudden onset of vertigo • persistent increasing vertigo • persistent neurosensory hearing loss • visual findings (nystagmus) –19 –20 BAROTRAUMA Case • A 20 year old female on their 3rd dive descends • INNER EAR INJURY rapidly to 15 meters. She had trouble Valsalva-ing –Treatment on descent and experienced stabbing pain in the forehead for 30 sec before clearing her ears, on • R/O Air Gas Embolism or Decompression arrival at surface she took off her mask and had Sickness profuse epistaxis. • strict bed rest •This is: • avoid straining (stool softeners, antiemetics, • A barotrauma ear squeeze antivertigo medications, sedation) • B: Type I DCS (the bends) • ENT REFERRAL: standard of care is surgery • C: Barotrauma sinus squeeze within 24 hours • D: Arterial Gas Embolism –21 –22 BAROTRAUMA BAROTRAUMA •SINUS • TOOTH – obstructed sinus – Prevention is the key! ostium (infection, allergy, anatomy) – Pain in tooth on ascent – Pain and bleeding – Predisposing Factors after squeeze or •dental disease reverse sq. • inadequate dental restorations –NO diving • recent dental work –decongestants – observe for infection Drshark2685.blogspot.com –23 –24 4 BAROTRAUMA BAROTRAUMA • FACE MASK SQUEEZE • ABDOMINAL SQUEEZE – failure to clear face mask on descent – usually from panic ascent – subconjunctival hemorrhages – antacid use – no treatment necessary – overbreathing and air swallowing – symptoms abate with descent Lester Quayle and Rita Barton, Duke University –25 –26 BAROTRAUMA Case •PULMONARY • A 23 y/o male is diving for the 4th time ever at 10 meters, he sees a rock lobster and panics. He – Squeeze swims as fast as he can to the surface while • deep breath-hold dive to a depth at which lung volume is holding his breath, on the surface he has aphasia, reduced below residual volume an weakness in his LUE of handgrip and wrist –Over expansion flexion. •This is: • intra alveolar hemorrhage, exudate •chest pain • Type II DCS(the bends) • progressive dyspnea • Arterial Gas Embolism • progressive frothy, bloody sputum • Pulmonary Squeeze – Can be accompanied by AGE and DCS • Round window rupture –27 –28 PULMONARY OVERINFLATION SYNDROMES (POIS) • MEDIASTINAL EMPHYSEMA – results when gas expansion forces gas into the loose mediastinal tissues in the middle of the chest – symptoms: chest pain behind the sternum (tightness, burning) – no other symptoms – symptoms generally do not get worse – no treatment is necessary –O2 may reduce symptoms faster Univ of Maryland –29 –30 5 PULMONARY OVERINFLATION SYNDROMES (POIS) • SUBCUTANEOUS EMPHYSEMA – results from expansion of gas which has leaked from the mediastinum into the subcutaneous tissues of the neck – symptoms: feels like “Rice Krispies” under the skin – there may be a voice change due to pressure on the larynx – no treatment is necessary –O2 may reduce symptoms faster –31 –32 PULMONARY PULMONARY OVERINFLATION OVERINFLATION SYNDROMES (POIS) SYNDROMES (POIS) •PNEUMOTHORAX • ARTERIAL GAS EMBOLISM – accumulation of gas within the pleural • THE MOST SERIOUS POTENTIAL space COMPLICATION OF DIVING CAUSED BY – symptoms: chest pain, more likely lateral EXCESS AIR PRESSURE IN THE CHEST!! or apical; cough; SOB • alveolar rupture with injection of air into – Treatment: 100% O2 and chest tube prn capillary so that a bolus (bubble) of air enters pulmonary veins and left ventricle • Occurs suddenly, usually after a rapid ascent –33 –34 PULMONARY Arterial Gas embolism OVERINFLATION SYNDROMES (POIS) • Presents as embolic stroke • ARTERIAL GAS EMBOLISM – A DETAILED neuro exam is critical – the brain is the most significant site of • Majority in MCA distribution embolus –Aphasia –symptoms: ANY type of neurologic sign or –Apraxia symptom (unconsciousness, weakness, – Hemiparesis paralysis, paraesthesia, etc) within 10 min – Hemisensory loss of surfacing • Minority Vertebral Basilar – AGEs do not go to the spine (think DCS) – Visual or cerebellar deficits –tx: O2 & IMMEDIATE RECOMPRESSION –35 –36 6 Decompression sickness (DCS) •Inert Gas (N2) saturated in tissue on dive • As diver ascends gas comes out of solution • Gas forms bubbles-causes vascular obstruction, ischemia, cell death • Bubbles activate clotting system, cause plt clumping etc. also activate cytokines • Onset of sx is delayed unlike AGE –37 –38 Decompression Sickness (DCS) Decompression Sickness (DCS) •Risk factors • Mitigators –Obesity – Being physically fit –Age reduces risk of – – Injuries Decompression Sickness (DCS) – – Excessive exercise –Dehydration –39 –40 Decompression sickness (DCS)- Classification Decompression sickness (DCS) •Type I •Spinal – Usually sensory level, lower motor neuron sx, – PMS-Pain, Marbling, Swelling bowel bladder dysfunction • “Cutis marmarata” • Cerebral • Bone/joint pain – Fatigue, upper motor neuron sx, • Not life threatening • Pulmonary (chokes) •Type II – Cough, chest pain – Serious neurological symptoms • Inner ear (staggers) • Cerebral, Spinal cord, Pulmonary, Inner ear – Vertigo, N&V, tinnitus, hearing loss – Most common with Heliox diving –41 –42 7 Treatment •Type I- – Can be managed with Non Steroidal Anti-Inflammatory Drugs and observation if remote from a chamber –Hydration – USN Treatment Table 5 •Type II – Needs emergent recompression, USN TT6 or higher – IV
Load more

Recommended publications
  • Heat Stroke Heat Exhaustion
    Environmental Injuries Co lin G. Ka ide, MD , FACEP, FAAEM, UHM Associate Professor of Emergency Medicine Board-Certified Specialist in Hyperbaric Medicine Specialist in Wound Care The Ohio State University Wexner Medical Center The Most Dangerous Drug Combination… Accidental Testosterone Hypothermia and Alcohol! The most likely victims… Photo: Ralf Roletschek 1 Definition of Blizzard Hypothermia of Subnormal T° when the body is unable to generate sufficient heat to sustain normal functions Core Temperature < 95°F 1979 (35°C) Most Important Temperatures Thermoregulation 95°F (35° C) Hyper/Goofy The body uses a Poikilothermic shell to maintain a Homeothermic core 90°F (32°C) Shivering Stops Maintains core T° w/in 1.8°F(1°C) 80°F (26. 5°C) Vfib, Coma Hypothalamus Skin 65°F (18°C) Asystole Constant T° 96.896.8-- 100.4° F 2 Thermoregulation The 2 most important factors Only 3 Causes! Shivering (10x increase) Decreased Heat Production Initiated by low skin temperature Increased Heat Loss Warming the skin can abolish Impaired Thermoregulation shivering! Peripheral vasoconstriction Sequesters heat Predisposing Predisposing Factors Factors Decreased Production Increased Loss –Endocrine problems Radiation Evaporation • Thyroid Conduction* • Adrenal Axis Convection** –Malnutrition *Depends on conducting material **Depends on wind velocity –Neuromuscular disease 3 Predisposing Systemic Responses CNS Factors T°< 90°F (34°C) Impaired Regulation Hyperactivity, excitability, recklessness CNS injury T°< 80°F (27°C) Hypothalamic injuries Loss of voluntary
    [Show full text]
  • Analysis of Accidents and Sickness of Divers and Scuba Divers at the Training Centre for Divesr and Scuba Divers of the Polish Army
    POLISH HYPERBARIC RESEARCH 2(71)2020 Journal of Polish Hyperbaric Medicine and Technology Society ANALYSIS OF ACCIDENTS AND SICKNESS OF DIVERS AND SCUBA DIVERS AT THE TRAINING CENTRE FOR DIVESR AND SCUBA DIVERS OF THE POLISH ARMY Władysław Wolański Polish Army Diver and Diver Training Centre, Naval Psychological Laboratory, Gdynia, Poland ARTICLE INFO PolHypRes 2020 Vol. 71 Issue 2 pp. 75 – 78 ISSN: 1734-7009 eISSN: 2084-0535 DOI: 10.2478/phr-2020-0013 Pages: 14, figures: 0, tables: 0 page www of the periodical: www.phr.net.pl Publisher Polish Hyperbaric Medicine and Technology Society 2020 Vol. 71 Issue 2 INTRODUCTION The first group of diseases occurs as a result of mechanical action directly on the body of the diver. Among The prerequisite for the prevention of diving- them are: ear and paranasal sinus barotrauma, pulmonary related sicknesses and accidents is strict compliance with barotrauma, crushing. both technical and medical regulations during diving In the second group we most often encounter the training and work [3,4]. consequences of the toxic effects of gaseous components of A very important issue is good knowledge of the air on the human body. This group includes decompression work of a diver and the anticipation of possible dangers by sickness, oxygen poisoning, nitrogen poisoning, CO2 the personnel participating in the dive [1]. The Military poisoning, carbon monoxide (CO) poisoning. Maritime Medical Committee (WKML) determines When analysing the causes of diving sicknesses whether or not an individual is healthy enough to dive, and accidents at the Diver and Scuba Diver Training Centre granting those who meet the required standards a medical of the Polish Army, certain groups of additional factors certificate that is valid for one year [1,2].
    [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]
  • Pulmonary Barotrauma During Hypoxia in a Diver While Underwater
    POLISH HYPERBARIC RESEARCH 2(71)2020 Journal of Polish Hyperbaric Medicine and Technology Society PULMONARY BAROTRAUMA DURING HYPOXIA IN A DIVER WHILE UNDERWATER Brunon Kierznikowicz, Władysław Wolański, Romuald Olszański Institute of Maritime and Tropical Medicine of the Military Medical Academy, Gdynia, Poland ABSTRACT The article describes a diver performing a dive at small depths in a dry suit, breathing from a single-stage apparatus placed on his back. As a result of training deficiencies, the diver began breathing from inside the suit, which led to hypoxia and subsequent uncontrolled ascent. Upon returning to the surface, the diver developed neurological symptoms based on which a diagnosis of pulmonary barotrauma was made. The diver was successfully treated with therapeutic recompression-decompression. Keywords: diving, accident, hypoxia, pulmonary barotrauma. ARTICLE INFO PolHypRes 2020 Vol. 71 Issue 2 pp. 45 – 50 ISSN: 1734-7009 eISSN: 2084-0535 Casuistic (case description) article DOI: 10.2478/phr-2020-0009 Pages: 6, figures: 0, tables: 1 Originally published in the Naval Health Service Yearbook 1977-1978 page www of the periodical: www.phr.net.pl Acceptance for print in PHR: 27.10.2019 r. Publisher Polish Hyperbaric Medicine and Technology Society 2020 Vol. 71 Issue 2 INTRODUCTION that he suddenly experienced an "impact" from an increased amount of air flowing into his lungs during In recent years, we can observe a continuous inhalation. Fearing a lung injury, he immediately pulled the dynamic development of diving technology. At the same mouthpiece out of his mouth and started breathing air time, the spectrum of works carried out by scuba divers for from inside the suit for about 2 minutes.
    [Show full text]
  • Review of Human Physiology in the Underwater Environment
    Available online at www.ijmrhs.com cal R edi ese M ar of c l h a & n r H u e o a J l l t h International Journal of Medical Research & a S n ISSN No: 2319-5886 o c i t i Health Sciences, 2019, 8(8): 117-121 e a n n c r e e t s n I • • IJ M R H S Review of Human Physiology in the Underwater Environment Oktiyas Muzaky Luthfi1,2* 1 Marine Science University of Brawijaya, Malang, Indonesia 2 Fisheries Diving School, University of Brawijaya, Malang, Indonesia *Corresponding e-mail: [email protected] ABSTRACT Since before centuries, human tries hard to explore underwater and in 1940’s human-introduced an important and revolutionary gear i.e. scuba that allowed human-made long interaction in the underwater world. Since diving using pressure gas under pressure environment, it should be considered to remember gas law (Boyle’s law). The gas law gives a clear understanding of physiological consequences related to diving diseases such as barotrauma or condition in which tissue or organ is damage due to gas pressure. The organ which has direct effect related to compression and expansion of gas were lungs, ear, and sinus. These organs were common and potentially fatigue injury for a diver. In this article we shall review the history of scuba diving, physical stress caused underwater environment, physiology adaptation of lung, ear, and sinus, and diving disease. Keywords: Barotrauma, Boyle’s law, Scuba, Barine, Physical stress INTRODUCTION The underwater world is a place where many people dream to explore it.
    [Show full text]
  • Placental Transfusion for Asphyxiated Infants
    UC Davis UC Davis Previously Published Works Title Placental Transfusion for Asphyxiated Infants. Permalink https://escholarship.org/uc/item/9c95r3js Authors Katheria, Anup C Rich, Wade D Bava, Sunita et al. Publication Date 2019 DOI 10.3389/fped.2019.00473 Peer reviewed eScholarship.org Powered by the California Digital Library University of California REVIEW published: 20 November 2019 doi: 10.3389/fped.2019.00473 Placental Transfusion for Asphyxiated Infants Anup C. Katheria 1*, Wade D. Rich 1, Sunita Bava 2 and Satyan Lakshminrusimha 3 1 Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States, 2 Independent Researcher, San Diego, CA, United States, 3 Department of Pediatrics, University of California, Davis, Davis, CA, United States The current recommendation for umbilical cord management of non-vigorous infants (limp, pale, and not breathing) who need resuscitation at birth is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence for delayed cord clamping (DCC) or umbilical cord milking (UCM). These methods may provide a neuroprotective mechanism that also facilitates cardiovascular transition for non-vigorous infants at birth. Keywords: placental transfusion, cord milking, delayed cord clamping, newborn, asphyxia BACKGROUND An estimated one million newborns worldwide suffer from perinatal asphyxia which lead them to being at risk for developing hypoxic-ischemic encephalopathy (HIE) due to inadequate blood flow and oxygen delivery to the neonatal brain and other vital organs such as the heart and kidneys. The incidence of HIE is 1–3/1,000 term births in high-income countries but is 15–20 times greater in low to middle-income countries.
    [Show full text]
  • Title: Recognizing Barotrauma As an Unexpected Complication of High Flow Nasal Cannula
    Title: Recognizing barotrauma as an unexpected complication of high flow nasal cannula Introduction: Spontaneous pneumomediastinum (SPM) is a rare condition defined as free air in the mediastinum without an apparent trauma. It is commonly associated with barotrauma in asthma and COPD patients. High flow nasal cannula (HFNC) has been routinely used for hypoxemic respiratory failure. We present a case of the development of SPM with extensive subcutaneous emphysema with the use of HFNC for hypoxic respiratory failure. Case Presentation: 78 year old Caucasian female with history of interstitial pulmonary fibrosis and COPD was discharged to LTACH after prolonged hospitalization for influenza-A infection complicated by acute on chronic respiratory failure. She was started on supplemental oxygen using HFNC that was progressively increased to 60 liters/min with 100% FiO2 for persistent hypoxia. Over the next four days, she was noted to have worsening facial and neck swelling with progressive dyspnea leading to transfer to the hospital. CT scan of chest noted for extensive pneumomediastinum involving the middle and anterior mediastinum with extensive subcutaneous emphysema throughout the anterior and moderately posterior chest wall extending to lower neck. Lung parenchyma revealed underlying interstitial with patchy airspace disease without evident pneumothorax. She was started on 100% FIO2 with non- rebreather mask. For symptomatic relief, Cardiothoracic surgery performed bilateral anterior chest blowhole incisions and application of negative vacuum-assisted closure on anterior chest with dramatic improvement in subcutaneous emphysema and facial swelling with persistent pneumomediastinum. Patent’s pneumomediastinum and respiratory failure persisted with high oxygen requirement with non- rebreather mask. Due to underlying advanced lung disease and persistent respiratory failure , patient’s family opted for palliative management with comfort measure and patient was transferred to hospice care.
    [Show full text]
  • MRI Findings of Otic and Sinus Barotrauma in Patients with Carbon Monoxide Poisoning During Hyperbaric Oxygen Therapy
    MRI Findings of Otic and Sinus Barotrauma in Patients with Carbon Monoxide Poisoning during Hyperbaric Oxygen Therapy Ping Wang, Xiao-Ming Zhang*, Zhao-Hua Zhai, Pei-Ling Li Sichuan Key Laboratory of Medical Imaging, and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan, China Abstract Background and Purpose: To study the MRI findings of otic and sinus barotrauma in patients with carbon monoxide(CO) poisoning during hyperbaric oxygen (HBO) therapy and examine the discrepancies of otic and sinus abnormalities on MRI between barotrauma and acute otitis media with effusion. Materials and Methods: Eighty patients with CO-poisoning diagnosed with otic and sinus barotrauma after HBO therapy were recruited. Brain MRI was performed to predict delayed encephalopathy. Over the same period, 88 patients with acute otitis media with effusion on MRI served as control. The abnormalities of the middle ear and paranasal sinuses on MRI were noted and were compared between groups. Nine patients with barotrauma were followed up by MRI. Results: In the barotrauma group, 92.5% of patients had bilateral middle ear abnormalities on MRI, and 60% of patients had both middle ear cavity and mastoid cavity abnormalities on MRI in both ears. Both rates were higher than those in the control group (p = 0.000). In the two groups, most abnormalities on MRI were observed in the mastoid cavity. The rate of sinus abnormalities of barotrauma was 66.3%, which was higher than the 50% in the control group (p = 0.033). In the nine patients with barotrauma followed up by MRI, the otic barotrauma and sinus abnormalities had worsened in 2 patients and 5 patients, respectively.
    [Show full text]
  • Toxicity Associated with Carbon Monoxide Louise W
    Clin Lab Med 26 (2006) 99–125 Toxicity Associated with Carbon Monoxide Louise W. Kao, MDa,b,*, Kristine A. Nan˜ agas, MDa,b aDepartment of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA bMedical Toxicology of Indiana, Indiana Poison Center, Indianapolis, IN, USA Carbon monoxide (CO) has been called a ‘‘great mimicker.’’ The clinical presentations associated with CO toxicity may be diverse and nonspecific, including syncope, new-onset seizure, flu-like illness, headache, and chest pain. Unrecognized CO exposure may lead to significant morbidity and mortality. Even when the diagnosis is certain, appropriate therapy is widely debated. Epidemiology and sources CO is a colorless, odorless, nonirritating gas produced primarily by incomplete combustion of any carbonaceous fossil fuel. CO is the leading cause of poisoning mortality in the United States [1,2] and may be responsible for more than half of all fatal poisonings worldwide [3].An estimated 5000 to 6000 people die in the United States each year as a result of CO exposure [2]. From 1968 to 1998, the Centers for Disease Control reported that non–fire-related CO poisoning caused or contributed to 116,703 deaths, 70.6% of which were due to motor vehicle exhaust and 29% of which were unintentional [4]. Although most accidental deaths are due to house fires and automobile exhaust, consumer products such as indoor heaters and stoves contribute to approximately 180 to 200 annual deaths [5]. Unintentional deaths peak in the winter months, when heating systems are being used and windows are closed [2]. Portions of this article were previously published in Holstege CP, Rusyniak DE: Medical Toxicology.
    [Show full text]
  • Results of the Commercialisation Of
    POLISH HYPERBARIC RESEARCH 4(53)2015 Journal of Polish Hyperbaric Medicine and Technology Society PULMONARY BAROTRAUMA IN DIVERS VS PROCEDURES INITIATED BY EMERGENCY MEDICAL PERSONEL Martyna Krukowska, Katarzyna Jańczuk, Anna Ślifirczyk, Marta Kowalenko Pope John Paul II Higher School of Education in Biała Podlaska, Medical Rescue Institute A BSTRACT Introduction: Pulmonary barotrauma consists in the damage of pulmonary tissues resulting from pressure differences in the body and the surroundings. Barotrauma may occur during diver's ascent with a held breath. Objective: Presentation of symptoms in divers performing dives at shallow depths. A detailed description of pulmonary barotrauma as a direct hazard to life. Rescue procedure in the case of an occurrence of pulmonary barotrauma, methods of prevention. Abridged description of the state of knowledge: Proper equipment preparation, systematic diving training, as well as systematic medical control aimed at conducting medical examinations with regard to staying under water, all constitute primary preventive measures. At the moment of an occurrence of pulmonary barotrauma in a diver it is necessary to perform first aid activities by qualified medical personnel and arrange for a quick transportation to the nearest hyperbaric centre. Summary: Commonly, pulmonary barotrauma concerns individuals diving at depths up to 10 metres. Pulmonary barotrauma is a state of danger to one's health and life. Proper procedures at the scene of an accident as well as quick transportation to a hyperbaric chamber increase the chance of one's recovery and may constitute the necessary condition during rescue activities. Keywords: pulmonary barotrauma, medical rescuer, arterial gas embolism (AGE), hyperbaric treatment. AR TICLE INFO PolHypRes 2015 Vol.
    [Show full text]
  • Underwater Expeditions
    27 UNDERWATER EXPEDITIONS Andrew Pitkin he increasing use of diving as a means of exploration in the underwater environ- Tment has resulted in a substantial rise in the popularity of underwater expedi- tions. Many such projects have additional scientific or ecological objectives and may involve large numbers of participants over many months or years. It is therefore un- surprising that most expeditions desire or require medical support. Diving is an equipment-centred activity and, because of this, diving expeditions usually remain within closer reach of “civilisation” than many others. A notable fea- ture of diving-related expeditions is that the variety of illnesses caused uniquely by hyperbaric exposure requires a recompression chamber for definitive treatment; this is not an item easily carried in a medical kit. Fitness to dive Participants in a diving expedition may have diving qualifications from any of a number of training organisations, which have varying requirements for fitness to dive. In the UK the medical examination for commercial divers is much more com- prehensive than for sports divers, reflecting the occupational nature of the risk. In re- cent years the UK’s Health and Safety Executive (HSE) has adopted a pragmatic risk assessment approach to diving regulations and fitness to dive; the standards required for a North Sea saturation diver are not necessarily those required of an underwater cameraman filming marine life in a tropical aquarium, although both may be em- ployed as divers. A similar approach should be adopted for expedition divers with the obvious proviso that diving, for any form of reward, brings such diving within the jurisdiction of the HSE or analogous industrial health organisation.
    [Show full text]
  • Middle-Ear Barotrauma After Hyperbaric Oxygen Therapy
    UHM 2010, Vol. 37, No. 4 – MIDDLE-EAR BAROTRAUMA AFTER HBO2 Middle-ear barotrauma after hyperbaric oxygen therapy JACQUES BESSEREAU 1,2, ALEXIS TABAH 2,3, NICOLAS GENOTELLE 2, ADRIEN FRANÇAIS 3, MATHIEU COULANGE 1, DJILLALI ANNANE 2 1 Hyperbaric Medicine Centre, Pôle RUSH, Sainte-Marguerite Hospital, Marseille, France; 2 Intensive Care Unit and Hyperbaric Medicine, Raymond Poincaré Hospital, Garches, France; 3 INSERM U823; university Grenoble 1 –Albert Bonniot Institute, Grenoble, France CORRESPONDING AUTHOR: Dr. Alexis Tabah – [email protected] ABSTRACT Background: Middle-ear barotrauma (MEB) is one of the most common side effects of hyperbaric oxygen therapy (HBO2). The incidence of MEB has been shown to vary between treatment centers and patients. This study was aimed to determine which patients are at high risk of MEB. Materials and methods: Prospective study including all the patients treated in a multiplace HBO2 chamber between January and December 2005. Scoring of MEB before and after HBO2 by otoscopy was performed using the Haines and Harris classification. Results: We included 130 patients: 53 Males, 37.5 ± 20.5 years old; 76% were treated for CO poisoning, 11% for iatrogenic gas embolism, 12% for decompression sickness and 4% for necrotizing soft tissue infection. 13% were intubated. MEB occurred in 13.6% of the patients (12.4% of the conscious and 24.4% of the intubated patients, p=0.26). Risk factors for MEB were: repetitive treatments and difficulties with pressure equalization. There was no influence of age, sex or mechanical ventilation on the occurrence of MEB. Conclusions: MEB induced by HBO2 occurred in 13.6% of the patients.
    [Show full text]