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PubMed1985

Air and nitrox saturation decompression: a report of 4 schedules and 77 subjects.

Seventy-seven subjects were decompressed from air or nitrogen-oxygen (nitrox) saturation exposures at 18.3 to 40.2 meters sea water (msw) [60 to 132 feet sea water (fsw)] using four different decompression schedules. A h schedule for decompression from an air saturation-excursion profile at 18.3 msw (60 fsw) resulted in pain-only decompression sickness (DCS) symptoms in 2 of 23 subjects. A 32 and 35 h schedule from a different air saturation profile at 19.8 and 22.9 msw (65 and 75 fsw), respectively, resulted in DCS symptoms in 1 of 24 subjects. A third and fourth schedule for air or nitrox saturation at 40.2 msw (132 fsw) resulted in DCS symptoms in 3 of 12 and 1 of 18, respectively. No serious (type II) symptoms were observed as a result of any of the decompressions. All DCS cases consisted of knee pain occurring either in the last 3 msw of the decompression or shortly after surfacing. Doppler ultrasound monitoring revealed venous gas emboli (VGE) in several subjects, but generally only shallow to 6.1 msw (20 fsw). Results demonstrate an overall DCS incidence of 9%, and all cases were pain-only and localized to the knee. The third schedule (U.S. Navy heliox saturation decompression schedule) seems to produce a higher incidence of DCS than the other schedules when used in air or nitrox exposures. Differentiation between the schedules designed for nitrox was impossible due to the limited number of subjects in each and the variable nature of the exposures.

Adult↗
PubMed1996

Diving the wreck: risk and injury in sport scuba diving.

This paper utilizes psychoanalytic theory to examine risk and injury in the case of a male deep sea diver. It examines the unconscious conflicts which appeared to fuel the diver's involvement in deep diving and to lead to a near fatal incident of decompression sickness. Particular attention is paid to the role of the diver's father in the evolution of the preoedipal and oedipal fantasies and conflicts which appear to be linked to the injury. The research is based on interviews with and fieldwork among recreational and deep divers.

Adult↗
PubMed2001

Diver with decompression injury, elevation of serum transaminase levels, and rhabdomyolysis.

A 43-year-old female recreational scuba diver presented to the emergency department 1 hour after a rapid, uncontrolled ascent. Her presentation included progressing confusion, slow and slurred speech, and complaints of headache and hypesthesia over her forearms and anterior thighs bilaterally. Differential diagnosis included arterial gas embolism and decompression sickness. She underwent recompression therapy with US Navy Table 6 within 120 minutes of her ascent. After recompression therapy, the patient had signs and symptoms consistent with severe rhabdomyolysis, including creatine kinase levels of 36,000 U/L and myoglobinuria.

Adult↗
PubMed1980

Venous gas bubbles while flying with cabin altitudes of airliners or general aviation aircraft 3 hours after diving.

Decompression venous gas bubbles were detected with the precordial Doppler utrasound technique in humans at simulated altitudes of 1,000-3,000 m 3 h after no-stage decompression dives to 15 or 39 m. Bubbles were detected at 3,000 m in a total of 60% of the subjects: in 90% after the 100-min shallow dives to 15 m with some bubbles present in the first minutes (mean onset 12 min), and in only 30% after the 10-min deeper dives to 39 m with later appearances of bubbles (mean onset 28 min). At both 2,000 and 1,000 m bubbles could also be detected, sometimes in the first minutes. The risk of decompression sickness must be considered high with the amount of gas bubbles found, even though only uncertain symptoms appeared in this study. Thus, a safe interval between ordinary SCUBA-diving and flying in airliners or general aviation aircraft seems to be more than 3 h.

Adult↗
PubMed2005

Physiological and clinical aspects of apnea diving.

Apnea diving is a fascinating example of applied physiology. The record for apnea diving as an extreme sport is 171 meters, 8:58 minutes. The short time beneath the surface induces profound cardiovascular and respiratory effects. Variations of blood-gas tensions result from the interaction of metabolism and the rapid sequence of compression and decompression. Decompression sickness is possible. Apnea divers can reach depths beyond the theoretic physiologic limit by using the lung-packing maneuver. Apnea divers exhibit a fall in heart rate, which can be trained and is an oxygen-conserving effect, but increases the incidence of ventricular arrhythmia.

Apnea↗
PubMed1969

Hazards in hyperbaric medicine.

During the period April 1965 to April 1968 observations were made on 285 patients and 357 staff exposed to air and oxygen at pressures of 1 to 3 atmospheres absolute in a hyperbaric unit. Decompression sickness was not noted and an annual radiological skeletal survey failed to show aseptic bone necrosis; the incidence of otitic barotrauma was 4.7%. Oxygen toxicity was not observed in any patient. It is suggested that pressures in this range are relatively safe in a specialized medical hyperbaric environment.

Adolescent↗
PubMed1981

The role of computed tomography in the management of dysbaric diving accidents.

The use of computed tomography (CT) in the diagnosis and management of decompression sickness and diving air embolism has not been previously reported. Two unusual cases of neurological dysbarism are presented in which CT was helpful in the postrecompression evaluation and treatment. CT showed areas of infarction and of edema of the brain. The role of CT in managing dysbaric diving accidents is discussed.

Accidents↗
PubMed1981

Chokes--favorable response to delayed recompression therapy: a case report.

The pulmonary manifestations of decompression sickness have been attributed to various mechanisms, all of which invoke bubble formation and presence in the lung as the cause of symptoms. A case of persistent "chokes" syndrome, which responded to recompression of 72 h after presentation, is described. The possible physiological mechanisms and the late response to therapy is discussed.

Adult↗
PubMedDate not supplied

Dual-frequency ultrasound for detecting and sizing bubbles.

ISS construction and Mars exploration require extensive extravehicular activity (EVA), exposing crewmembers to increased decompression sickness risk. Improved bubble detection technologies could help increase EVA efficiency and safety. Creare Inc. has developed a bubble detection and sizing instrument using dual-frequency ultrasound. The device emits "pump" and "image" signals at two frequencies. The low-frequency pump signal causes an appropriately-sized bubble to resonate. When the image frequency hits a resonating bubble, mixing signals are returned at the sum and difference of the two frequencies. To test the feasibility of transcutaneous intravascular detection, intravascular bubbles in anesthetized swine were produced using agitated saline and decompression stress. Ultrasonic transducers on the chest provided the two frequencies. Mixing signals were detected transthoracically in the right atrium using both methods. A histogram of estimated bubble sizes could be constructed. Bubbles can be detected and sized transthoracically in the right atrium using dual-frequency ultrasound.

Animals↗
PubMed2001

[Osteonecrosis].

In orthopedic pathology, the pathologist is most commonly faced with the study of resected femoral heads for osteonecrosis. Such a study necessitates a knowledge of clinical findings, of physiopathology and chiefly of radiological findings. Osteonecrosis of the femoral head following fracture has been reported with four morphological stages which are very precisely described. In the same way, idiopathic, non traumatic, or primary osteonecrosis is covered, stressing the putative etiological factors and the most important findings of imaging. The review includes also the skeletal manifestations of decompression sickness as well as bone infarctions not associated with caisson disease, and spontaneous osteonecrosis of the knee. From the recruitment of the Hospital for Special Surgery, NY, it has been recently reported that a significant number of patients regarded as cases of osteonecrosis, either in the femoral head or in the knee, are actually cases of subchondral insufficiency fractures.

Decompression Sickness↗
PubMed2004

Effects of denitrogenation on bubble formation during decompression in rabbits.

OBJECTIVE: To explore the effect of different degrees of denitrogenation on decompression sickness. METHOD: Twenty-four rabbits were randomly divided into control group, 100% oxygen inhalation 30 min group, 60 min group and 120 min group. The rabbits were anesthetized and ventilated by mechanical ventilator. After 0, 30, 60, and 120 min of denitrogenation by inhalation of 100% oxygen, the rabbits were exposed to 11000 m for 30 min. The gas bubbles generated in the body of rabbits were detected and monitored by a Doppler ultrasound detector over the precordium. RESULT: Time to bubble appearance increased with time of 100% oxygen inhalation during altitude decompression. As compared with the control group, time to bubble appearance lengthened significantly in 100% oxygen inhalation 60 min and 120 min groups (P<0.01). Time to bubble appearance was positively correlated with time of 100% oxygen inhalation (P<0.01). Accumulative number of bubbles decreased with the time of 100% oxygen inhalation. As compared with the control group, accumulative number of bubbles decreased significantly in 100% oxygen inhalation of 60 min and 120 min groups (P<0.01). Accumulative number of bubbles was negatively correlated with time of 100% oxygen inhalation (P<0.01). CONCLUSION: Denitrogenation by inhalation of 100% oxygen for 60 min and 120 min may reduce the generation of gas bubbles in rabbits when decompressed to an altitude of 11000 m.

Animals↗
PubMed1986

[Complications of decompression of the internal ear during diving].

Inner ear decompression sickness belongs inner ear barotrauma. It occurs after a dive with factors of risk. The diagnostic needs an accurate history and physical examination which allows emergency treatment: therapeutic recompression, then hyperbaric oxygen and perfusions of vasodilators + corticoids. The symptomatology is mainly vestibular and the discussion between peripheric and/or central lesions is still open.

Adult↗
PubMed1993

[Otorhinolaryngologic aspects of diving sports].

ENT disorders are the most common of all medical problems of diving. This review summarizes the specific conditions and ENT diseases in Scuba diving. During compression failure to equalize the pressure of air-filled cavities surrounded by bone deprives the middle ear or sinuses of aeration. Middle ear barotrauma is the most common barotrauma encountered in divers while sinus barotrauma and especially inner ear barotrauma (with rupture of the round or oval window) are less common. Decompression sickness in primarily the result of inert gas bubbles; deafness and vertigo may result if the inner ear is involved. The ENT examination necessary for assessment of diving fitness focuses on the middle and inner ear as well as the nose, sinuses and larynx. A list of ENT contra-indications is presented that mandate temporary or permanent disqualification from diving.

Barotrauma↗
PubMed1985

Damage to the middle ear and the inner ear in underwater divers.

Postmortem human tissue from recently deceased divers was processed histologically to assess any inner and middle ear damage that could have resulted from the effects of pressure during diving. The following new findings are particularly noteworthy. In one diver, ascent while breath holding resulted in the rupture of the ear drum and blood in the middle ear, in addition to pulmonary barotrauma. In a second diver, following inner ear decompression sickness, new bone growth, similar to that described earlier in experimental studies with the squirrel monkey, was observed in the arms of one of the semicircular canals. These observations are further confirmation that otologic disorders can be a serious threat to divers.

Barotrauma↗
PubMed1975

Bubble growth and mechanical properties of tissue in decompression.

A survey of decompression literature leads to the conclusion that when tissue is subjected to gaseous supersaturation, pre-existing gas micronuclei grow into the gas bubbles which are routinely observed in decompression studies. These micronuclei may originate from mechanically induced tribonucleation or cavitation within joints. A new tissue model for decompression sickness based upon failure theory in rubber is proposed. The model shows theoretically that pre-existing sea-level nuclei can be stabilized at depth by elastic forces in tissue. These same elastic forces restrain the growth of nuclei when supersaturation occurs. Mechanical stress will lower the gaseous supersaturation required for growth of nuclei. Gaseous supersaturation, mechanical stress, and the elastic properties of various tissues interact to produce unbounded bubble growth leading to tissue lesions when combined gaseous and mechanical supersaturation exceeds a threshold value. The recommendation is made that the high levels of supersaturation generally used for the decompression of men be reduced.

Animals↗
PubMed2001

Decrease in platelet count during saturation diving.

BACKGROUND: The change in platelet count (PC) occurring during saturation diving has rarely been discussed. We set out to clarify the details of this change in PC, and its relationship with: i) the storage depth and duration of the saturation dive, and ii) the presence of decompression bubbles. METHODS: In a total of 42 divers, the change in PC was measured in 8 simulated saturation dives (1992-1998) using a Deep Diving Simulator with decompression procedures based on the modified DUKE-GKSS schedule. Blood samples were taken before the dive, at the bottom (twice), during decompression, on surfacing, and about 1 wk after surfacing. Decompression bubbles were examined by ultrasonic M-mode echocardiography. RESULTS: PC (mean +/- SD x 10(4) x microl(-1)) was 23.9 +/- 4.85, 24.9 +/- 4.9, 24.2 +/- 4.8, 19.2 +/- 4.4*, 20.1 +/- 4.5*, 25.0 +/- 5.1 on the occasions listed above (*= p < 0.05 vs. pre-dive). The PC showed no correlation with either storage depth or dive duration. Decompression bubbles were detected during decompression in only 2 divers (4.8%), and the bubbles disappeared immediately after surfacing. In these 2 divers the decreases in PC values from baseline to the middle of decompression and on surfacing were 2 and 2.7 x 10(4) x microl(-1), and 3.4 and 1.7 x 10(4) x microl(-1) respectively. No diver complained of decompression sickness. CONCLUSION: The magnitude of the decrease in PC (< 5 x 10(4) x microl(-1)) and the time to recover to the pre-dive value (< 1 wk) suggests that changes in PC during saturation diving should not cause any clinical problems. The mechanisms underlying the decrease in PC remain unclear.

Adult↗
PubMed1979

Rehabilitation of Caisson's disease with spinal cord involvement.

Fifteen cases of Caisson's Disease or Decompression Sickness with spinal cord involvement treated at the Department of Rehabilitation Tan Tock Seng Hospital, from 1973 to 1978 are described. All the cases had bladder and bowel function involvement. Five cases developed bone complications, one of whom was referred to us primarily for rehabilitation after he had an operation for collapsed right femoral head which occurred two years after the incident.

Adult↗
PubMed1979

Ear damage due to diving.

Diving injury may affect all parts of the ear during all types of diving. Divers are regularly exposed to noise and 120 dB(A) is measured during ventilation of a hyperbaric chamber. Ear canal squeeze, possibly with drum perforation, may give a transient conductive hearing loss. Middle ear squeeze, possibly with drum perforation, also gives a transient conductive loss. Inner ear barotrauma, possibly with perilymph fistula, most often results in transient vertigo and lasting sensorineural high tone loss, often resembling a noise-induced loss. Decompression sickness and gas embolism can also damage the inner ear. A change of breathing gas during deep diving has damaged the labyrinth, most likely due to counter diffusion. The authors have seen two cases of over window perilymph fistula resulting from diving. One of them also suffered a burst ear drum on the same side. His hearing returned to normal after surgical repair.

Barotrauma↗