Diving Medicine for Scuba Divers 4th edition 2012 Published by Carl Edmonds Ocean Royale, 11/69-74 North Steyne Manly, NSW, 2095 Australia [email protected] First edition, October 1992 Second edition, April 1997 Third edition January 2010 Forth edition January 2012 National Library of Australia Catalogue 1. Submarine Medicine 2. Scuba Diving Injuries 3. Diving – physiological aspects Copyright: Carl Edmonds Title 1 of 1 - Diving Medicine for Scuba Divers ISBN: [978-0-646-52726-0] To download a free copy of this text, go to www.divingmedicine.info ! ! FOREWARD ! ! ! "#$%$&'! (&)! *+,(-+(.$/! 01)$/$&1"2! $&! $.3! .4$5)! (&)! 4$'467! 51381/.1)! 1)$.$9&2! 4(3! 859%$)1)! (! /95&153.9&1! 9:! ;&9<61)'1! :95! .41! )$%$&'! =1)$/(6! 859:133$9&(6>! ?9<2! "#$%$&'! 01)$/$&1! @! :95! */+,(! #$%153"! $3! (! /9&)1&31)2! 3$=86$:$1)! (&)! 6$'4.15! 8+,6$/(.$9&! :95! .41! '1&15(6! )$%$&'! 898+6(.$9&>! A41! (+.4953! @! #53! B)=9&)32! 0/C1&D$1! (&)! A49=(32! 4(%1! )9&1! (&! 1E/1661&.! F9,! 9:! 859%$)$&'! 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'$%1&! ,7! =7! )(+'4.152! ?(.(6$(2!.9!859)+/$&'!39=1!9:!.41!)$('5(=3!+31)!<$.4$&!.41!,99;>!G!(639!<$34!.9!.4(&;!=7! <$:12!#1&$312!:95!415!.$516133!3+8895.!(&)!8(.$1&/1!51'(5)$&'!=7!9:.1&!:5+3.5(.$&'!+31!9:! .41!0(/$&.934!/9=8+.15!(&)!&9$37!85$&.15!$&!/9=861.$&'!.4$3!.1E.!@!39=1.4$&'!341!&1%15! ,16$1%1)!<9+6)!51(667!1%15!1%1&.+(.1Z! Y9,!A49=(3! ! ()*!+,$!-*#!.%#!/%+$*%$+!$#0+0)%12!! John Pennefather, who assisted Carl Edmonds in reviewing and updating the text Clarrie Lawler, who supplied many excellent diagrams Richard Chesher, for spectacular photographs John Lippmann, CEO, DAN Asia-Pacific, for advice, corrections and preparation of both earlier and this edition Richard Pyle for technical diving diagrams Cis-Lunar Development Laboratorie DIVING MEDICINE FOR SCUBA DIVERS GENERAL DIVING RELATED BACKGROUND MEDICAL PROBLEMS 1. History of Diving 30. Hearing Loss 2. Physics 31. Disorientation 3. Physiology 32. Miscellaneous Disorders – 4. Breath-hold Diving Contact Lenses 5. Equipment Muscular Cramps 6. Diving Environments Other Ear Problems 7. Stress Disorders — Panic and Fatigue Headache 8. Female Divers Pulmonary Oedema (SDPE) Sunburn SPECIFIC DIVING DISEASES Seasickness (PRESSURE RELATED DISEASES) Jaw Joint Arthritis 9. Ear Barotrauma Explosions 10. Sinus Barotrauma 33. Unconsciousness in Divers 11. Pulmonary Barotrauma 34. Why Divers Die 12. Other Barotraumas 35. Sudden Death Syndrome 13.Decompression Theory & Physiology 36. Psychological Disorders 14. Decompression Procedures Tables 37. Drugs and Diving 15. Decompression Sickness Clinical 16. Decompression Sickness Treatment TREATMENT and PREVENTION 17. Dysbaric Osteonecrosis 38. Medical Examinations for Divers 18. Nitrogen Narcosis 39. First Aid Kit 19. HPNS 40. Oxygen Therapy Techniques 20. Hypoxia 41. Training and Safety Checklist 21. Oxygen Toxicity 42. Resuscitation Review 22. Carbon Dioxide Problems 23. Carbon Monoxide Toxicity RECENT DEVELOPMENTS 24. Breathing Gas Contamination 43. Technical Diving AQUATIC DISEASES APPENDICES 25. Drowning A. Diving Medical Library 26. Salt Water Aspiration Syndrome B. Emergency Contact Numbers 27. Cold and Hypothermia C. In-water O2 Recompression Therapy 28. Infections D. Divers Alert Network 29. Dangerous Marine Animals GEM of WISDOM, learnt the hard way. If a diver suffers an illness/accident that you cannot understand or prevent, then it will happen again – but often with more serious consequences. Chapter 1 All chapters, full text, free download, available at http://www.divingmedicine.info HISTORY of DIVING Historians are unable to identify the first divers. Probably the techniques they used were similar to those of the native pearl and sponge divers. They may have used a stone weight to ensure rapid descent, but it is unlikely that they could dive deeper than 30 metres, or spend longer than 2 minutes underwater. Later, diving was employed for military purposes (such as destroying ships anchoring cables, boom defences, etc.) and for salvage work. Divers took part in great naval battles between 1800 BC and 400 BC. Alexander the Great was said to have descended in a diving bell (circa 330 BC) but the details are scarce and some of the stories of the descent are fanciful. Commercial diving evolved through the 19th and 20th centuries and encompassed salvage and shell diving, extending into exploration, deep diving, off shore oil rigs, aquaculture, ecology and most importantly for you – recreational diving. The history of diving evolved in two directions. The first is the development of diving equipment – described in this chapter. The second is the understanding of diving physiology and medicine – described in the rest of this text. Fig. 1.1 A Roman historian, Pliny, recorded the earliest use of surface supplied breathing air by divers in AD77, when a breathing tube connected the diver to the surface. This possibly represents an Chapter 1 — 1 early "schnorkel". Its use was limited to very shallow dives, since man's respiratory muscles cannot draw air very far down from the surface – maximum half a metre. It was also depth limited due to the excessive volume of the breathing tube. Leonardo da Vinci sketched several designs for diving equipment and submarines. Many diagrams of divers' hoods can be found in other historical texts from 1500 AD onwards, but much of this equipment would not have worked at depths greater than a few feet. They did, however, attest to man's desire to remain below the surface for extended periods.