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PubMed2002

What you need to know about diving medicine but won't find in a textbook.

The old adage that 'if a patient in your emergency department (ED) is wearing a wetsuit, fins and a mask, then he/she probably has a diving related illness' is one that should be remembered. This is an obvious statement that should not need stating; however, simple clues can be missed or disregarded. This article will address issues that may confront emergency physicians and for which there are few resources to find the answers. It aims to explain the reasons behind some of the advice given during consultation with a hyperbaric physician. The second aim is to bring emergency physicians up to date with new diving practices and how these may impact upon traditional diving injuries. To achieve these aims, this article is a compilation of answers to frequently asked or pertinent questions related to diving medicine.

Decompression Sickness↗
PubMed2001

Diving medicine: contemporary topics and their controversies.

SCUBA diving is a popular recreational sport. Although serious injuries occur infrequently, when they do knowledge of diving medicine and/or where to obtain appropriate consultation is essential. The emergency physician is likely to be the first physician contact the injured diver has. We discuss 8 subjects in diving medicine which are contemporary, yet may have controversies associated with them. From this information the physician dealing primarily with the injured diver will have a basis for understanding and managing, as well as where to find additional help, for his/her patients' diving injuries.

Athletic Injuries↗
PubMed1977

[Bone and joint changes due to compressed air in divers and Caisson workers (author's transl)].

The radiological and morphological changes of Caisson disease in the skeleton are well known. The findings of interest to radiologists are described. Because of its position, its was possible to review a large number of divers in Kiel; these have been under observation for years, and even decades. The development, manifestation and course of chronic skeletal changes due to compressed air are described to compressed air are described and, according to severity, are classified into types 1 to 4. Late changes are discussed in detail, since these are of importance in relation to compensation.

Bone Diseases↗
PubMed2001

Administration of 100% oxygen in diving accidents--an evaluation of four emergency oxygen devices.

As the use of oxygen enhances the resorption of gas bubbles in decompression illness, it is recommended and generally accepted that the inspired oxygen concentration in emergency treatment of diving accidents has to be as close to 100% as possible. Therefore, several emergency oxygen devices are offered to the diving community but only with little data in literature on the efficacy of these devices. We tested four emergency oxygen devices with respect to efficacy of oxygen supply and breathing comfort at rest. Nine blinded volunteers had to breathe from the four systems with face mask and mouthpiece as well. Gases were measured with mass spectrometry during a 3 min interval from a capillary port close to the subject. The results showed that none of the systems was able to deliver 100% oxygen all the time, but in three systems inspiratory oxygen values were achieved, although in one system the nitrogen wash-out was slowed due to air contamination during inspiration. The fourth tested system frequently supplied the subjects simply with air while breathing at rest. We conclude from our study that it is difficult to achieve oxygen levels close to 100% in practice. Even in a perfectly working system, the interface between device and subject is a source of entrained air, especially when oxygen breathing has to be performed over a longer period of time. In addition, two of four systems had conceptional problems to supply the subjects with pure O2 during inspiration. None of the tested systems was perfectly designed to serve in such emergencies.

Adult↗
PubMed1996

Haemoconcentration in neurological decompression illness.

Decompression illness (DCI) is attributed to the formation of bubbles, resulting from the reduction of the ambient pressure. Circulating bubbles lead to capillary leak syndrome, extravasation of plasma and haemoconcentration. Experimental model on animals has shown that a haemoconcentration carried a poor prognosis. We measured the haematocrit level in fifty-eight consecutive sport divers, victims of neurological DCI, admitted to our hyperbaric center, and in sixteen control divers. No significant difference was found in the haematocrit values between the divers with neurological DCI (median 42.5%) and the controls (median 41.75%). The median haematocrit level was significantly higher for divers with neurological sequelae when compared with control (p = 0.01) or with divers without sequelae (p < 0.05). A haematocrit level > or = 48% was correlated with persistent neurological sequelae one month after the accident (p = 0.01). However, a haematocrit < 48% had no prognostic value.

Adult↗
PubMed1980

[Central nervous system damage after decompression accidents (author's transl)].

An increasing number of decompression accidents can be observed due to increasing popularity of diving and due to ignorance of its dangers. Permanent neurological damage is a frequent consequence of insufficient availability of treatment at the site of the accident. A 39-year-old man with a decompression accident showed the broad neurological symptomatology caused by multitopic lesions of the central nervous system. Apart from well known spinal symptoms manifold cerebral manifestations occurred. Mental and in particular neuropsychological defects could be observed beyond the purely neurological symptomatology.

Brain Diseases↗
PubMed2001

Early and late morphological effects of experimental HPNS--animal model of psychosis?

The high pressure neurological syndrome (HPNS), a neurological condition during elevated pressure especially in deep diving, has been simulated with experimental animals. Rats were subjected to 61 bars with slow pressure increase and one or two hours constant high pressure; subsequently the pressure was released to sea level within 20 seconds--leading to immediate oxygen depletion and death of animals--or with slow decompression rates allowing survival. In all animals, brains and partly other organs were investigated morphologically. In animals sacrificed immediately, subtle changes in different brain regions were found: symmetrical occurrence of dark neurons in the hippocampus formation, cortex and brain stem, reduced expression of tyrosin hydroxylase in the substantia nigra and enhanced expression of Bax protein in some of these regions. The dark neurons were only observed after aldehyde fixation, otherwise the brains were unaltered despite ultrarapid decrease of highly elevated pressure. In animals that were allowed to survive for different time periods, some of these subtle changes were equally noted by light and electron microscopy. Furthermore, the ventricles were enlarged, the astrocytic reaction in the hippocampus increased and some signs of the destruction of the adrenal gland were visible. We conclude, that HPNS leads to minimal changes within the nervous system. The behaviour of animals during pressure was slightly altered, the weights after the experiments reduced, but no lasting sequelae were noted. Since both in human and experimental deep diving conditions signs of psychosis were reported, this HPNS model must be considered as a tentative animal model of human psychosis.

Adrenal Glands↗