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Diving and Hyperbaric Medicine Jun 2018Divers suspected of suffering decompression illness (DCI) in locations remote from a recompression chamber are sometimes treated with in-water recompression (IWR). There... (Review)
Review
Divers suspected of suffering decompression illness (DCI) in locations remote from a recompression chamber are sometimes treated with in-water recompression (IWR). There are no data that establish the benefits of IWR compared to conventional first aid with surface oxygen and transport to the nearest chamber. However, the theoretical benefit of IWR is that it can be initiated with a very short delay to recompression after onset of manifestations of DCI. Retrospective analyses of the effect on outcome of increasing delay generally do not capture this very short delay achievable with IWR. However, in military training and experimental diving, delay to recompression is typically less than two hours and more than 90% of cases have complete resolution of manifestations during the first treatment, often within minutes of recompression. A major risk of IWR is that of an oxygen convulsion resulting in drowning. As a result, typical IWR oxygen-breathing protocols use shallower maximum depths (9 metres' sea water (msw), 191 kPa) and are shorter (1-3 hours) than standard recompression protocols for the initial treatment of DCI (e.g., US Navy Treatment Tables 5 and 6). There has been no experimentation with initial treatment of DCI at pressures less than 285 kPa since the original development of these treatment tables, when no differences in outcomes were seen between maximum pressures of 203 kPa (10 msw) and 285 kPa (18 msw) or deeper. These data and case series suggest that recompression treatment comprising pressures and durations similar to IWR protocols can be effective. The risk of IWR is not justified for treatment of mild symptoms likely to resolve spontaneously or for divers so functionally compromised that they would not be safe in the water. However, IWR conducted by properly trained and equipped divers may be justified for manifestations that are life or limb threatening where timely recompression is unavailable.
Topics: Decompression Sickness; Diving; Humans; Hyperbaric Oxygenation; Retrospective Studies; Water
PubMed: 29888380
DOI: 10.28920/dhm48.2.84-95 -
Heart (British Cardiac Society) Jun 2022As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses... (Review)
Review
As the popularity of scuba diving increases internationally, physicians interacting with divers in the clinical setting must be familiar with the cardiovascular stresses and risks inherent to this activity. Scuba presents a formidable cardiovascular challenge by combining unique environmental conditions with the physiologic demands of underwater exercise. Haemodynamic stresses encountered at depth include increased hydrostatic pressure leading to central shifts in plasma volume coupled with cold water stimuli leading to simultaneous parasympathetic and sympathetic autonomic responses. Among older divers and those with underlying cardiovascular risk factors, these physiologic changes increase acute cardiac risks while diving. Additional scuba risks, as a consequence of physical gas laws, include arterial gas emboli and decompression sickness. These pathologies are particularly dangerous with altered sensorium in hostile dive conditions. When present, the appropriate management of patent foramen ovale (PFO) is uncertain, but closure of PFO may reduce the risk of paradoxical gas embolism in divers with a prior history of decompression sickness. Finally, similar to other Masters-level athletes, divers with underlying traditional cardiovascular risk should undergo complete cardiac risk stratification to determine 'fitness-to-dive'. The presence of undertreated coronary artery disease, occult cardiomyopathy, channelopathy and arrhythmias must all be investigated and appropriately treated in order to ensure diver safety. A patient-centred approach facilitating shared decision-making between divers and experienced practitioners should be utilised in the management of prospective scuba divers.
Topics: Decompression Sickness; Diving; Embolism, Paradoxical; Foramen Ovale, Patent; Humans; Prospective Studies
PubMed: 34670825
DOI: 10.1136/heartjnl-2021-319601 -
Journal of Applied Physiology... Feb 2010
Topics: Animals; Anostraca; Decompression Sickness; Gases; Humans; Rats; Ultrasonography
PubMed: 20019159
DOI: 10.1152/japplphysiol.01384.2009 -
The New England Journal of Medicine Oct 2017
Topics: Adult; Decompression Sickness; Embolism, Air; Humans; Male; Portal Vein; Radiography, Abdominal; Skin; Tomography, X-Ray Computed; Vomiting
PubMed: 29045210
DOI: 10.1056/NEJMicm1615505 -
Pneumologie (Stuttgart, Germany) Sep 2016Decompression injuries occur on account of the special hyperbaric effects during the emerge phase and require superior therapeutic knowledge. Vitally important is... (Review)
Review
Decompression injuries occur on account of the special hyperbaric effects during the emerge phase and require superior therapeutic knowledge. Vitally important is emergency treatment with high concentrated oxygen at an early stage. Sever decompression injuries require oxygenation in a hyperbaric treatment chamber.
Topics: Decompression Sickness; Diving; Emergency Medical Services; Evidence-Based Medicine; Humans; Hyperbaric Oxygenation; Treatment Outcome
PubMed: 27603947
DOI: 10.1055/s-0042-111704 -
Paediatric Respiratory Reviews Jan 2017Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large,... (Review)
Review
Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.
Topics: Airway Obstruction; Breathing Exercises; Exercise; Exercise Test; Humans; Laryngeal Diseases; Laryngoplasty; Laryngoscopy; Patient Education as Topic; Respiratory Therapy
PubMed: 27492717
DOI: 10.1016/j.prrv.2016.07.003 -
Deutsches Arzteblatt International Sep 2015
Topics: Decompression Sickness; Diving; Foramen Ovale, Patent; Humans; Physical Examination
PubMed: 26396052
DOI: 10.3238/arztebl.2015.0614c -
Deutsches Arzteblatt International Feb 2015Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many... (Review)
Review
BACKGROUND
Diving is a popular sport, and some recreational divers have medical risk factors. Their health can be endangered by high extracorporeal (ambient) pressure and its many systemic effects.
METHODS
We review relevant publications on free (breath-hold) diving, scuba diving, medical evaluation for diving, barotrauma, decompression sickness, and diving with medical risk factors, which were retrieved by a selective search of PubMed.
RESULTS
Free diving or scuba diving, even at seemingly innocuous depths, puts considerable stress on the cardio - vascular system, ears, and lungs. Unexpected events while diving, diminished functional reserve, and pre-existing medical illnesses increase the risk of a diving accident. An international survey revealed that minor incidents occur in 1.3% of all dives, and decompression accidents in 2 of every 10 000 dives. A properly conducted medical examination to determine diving fitness, followed by appropriate counseling, can make a life-threatening diving accident less likely.
CONCLUSION
To be able to certify diving fitness and give competent medical advice about diving, physicians must be well informed about the physical and physiological changes of diving and the associated risks to health, and they need to know how to perform a medical evaluation of prospective divers. In Germany, any licensed physician may judge a person fit to dive. It is recommended that this be done in adherence to the relevant evaluation standards and recommendations of the medical specialty associations. Randomized controlled trials on the effect of preventive behavior would be desirable, as would a central registry of diving accidents.
Topics: Decompression Sickness; Diving; Foramen Ovale, Patent; Humans; Physical Examination
PubMed: 25797514
DOI: 10.3238/arztebl.2015.0147 -
European Respiratory Review : An... Jun 2016Recreational diving with self-contained underwater breathing apparatus (scuba) has grown in popularity. Asthma is a common disease with a similar prevalence in divers as... (Review)
Review
Recreational diving with self-contained underwater breathing apparatus (scuba) has grown in popularity. Asthma is a common disease with a similar prevalence in divers as in the general population. Due to theoretical concern about an increased risk for pulmonary barotrauma and decompression sickness in asthmatic divers, in the past the approach to asthmatic diver candidates was very conservative, with scuba disallowed. However, experience in the field and data in the current literature do not support this dogmatic approach. In this review the theoretical risk factors of diving with asthma, the epidemiological data and the recommended approach to the asthmatic diver candidate will be described.
Topics: Asthma; Decompression Sickness; Diving; Humans; Lung; Lung Injury; Risk Assessment; Risk Factors
PubMed: 27246598
DOI: 10.1183/16000617.0006-2016 -
Medicina (Kaunas, Lithuania) Oct 2022: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over...
: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over the last 50 years and DCS has become a rare event. New needs have evolved to evaluate the diving and decompression stress to improve the flexibility of the operations (minimum interval between dives, optimal oxygen levels, etc.). We monitored this stress in saturation divers during actual operations. : The monitoring included the detection of vascular gas emboli (VGE) and the changes in the vascular function measured by flow mediated dilatation (FMD) after final decompression to surface. Monitoring was performed onboard a diving support vessel operating in the North Sea at typical storage depths of 120 and 136 msw. A total of 49 divers signed an informed consent form and participated to the study. Data were collected on divers at surface, before the saturation and during the 9 h following the end of the final decompression. : VGE were detected in three divers at very low levels (insignificant), confirming the improvements achieved on saturation decompression procedures. As expected, the FMD showed an impairment of vascular function immediately at the end of the saturation in all divers but the divers fully recovered from these vascular changes in the next 9 following hours, regardless of the initial decompression starting depth. : These changes suggest an oxidative/inflammatory dimension to the diving/decompression stress during saturation that will require further monitoring investigations even if the vascular impairement is found to recover fast.
Topics: Humans; Diving; Decompression Sickness; Recovery of Function; Oxygen
PubMed: 36295636
DOI: 10.3390/medicina58101476