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1.
Eur Arch Otorhinolaryngol ; 281(8): 4057-4061, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38470517

ABSTRACT

OBJECTIVE: To discuss the link between inner ear decompression sickness and patent foramen ovale. MATERIALS AND METHODS: Monocentric and retrospective study on decompression sickness of the inner ear requiring hyperbaric chamber treatment, from 2014 to 2021. RESULTS: Sixty-one patients of inner ear decompression sickness were included in this study. Twenty-four patients had vestibular injuries, 28 cochlear injuries and 9 cochleo-vestibular injuries. Compression chamber treatment was given, using an oxygen-helium mixture with oxygen partial pressure (PIO2) limited to 2.8 atmosphere absolute (ATA). All vestibular accidents completely recovered without clinical sequelae. For cochlear accident only 10 out of 37 patients (27%) recovered completely. A right-left shunt (patent foramen oval or intra-pulmonary shunt) was found in 31.1% of patients with inner ear decompression sickness (p > 0.05). CONCLUSION: The presence of patent foramen oval in patients with inner ear decompression was not statistically significant in our study. Understanding of the pathophysiology of decompression illness and the physiology and anatomy of the labyrinth would suggest a mechanism of supersaturation with degassing in intra-labyrinthine liquids.


Subject(s)
Decompression Sickness , Foramen Ovale, Patent , Humans , Retrospective Studies , Male , Female , Decompression Sickness/therapy , Adult , Foramen Ovale, Patent/complications , Middle Aged , Aged , Hyperbaric Oxygenation/methods , Young Adult , Labyrinth Diseases , Ear, Inner , Adolescent
2.
Undersea Hyperb Med ; 51(2): 107-113, 2024.
Article in English | MEDLINE | ID: mdl-38985147

ABSTRACT

A widely accepted belief is that Nathaniel Henshaw was the first practitioner of hyperbaric medicine. He is said to have constructed the first hyperbaric chamber where he treated several disorders and provided opportunities to prevent disease and optimize well-being. While there is little doubt Henshaw was the first to conceptualize this unique medical technology, careful analysis of his treatise has convinced this writer that his was nothing more than a proposal. Henshaw's air chamber was never built. He would have failed to appreciate how its structural integrity could be maintained in the presence of enormous forces generated by envisioned changes in its internal pressure and, likewise, how its door could effectively seal the chamber during hypo-and hyperbaric use. Henshaw would have also failed to appreciate the limitations of his two proposed measuring devices and the toxic nature of one. Neither of these would have provided any quantitative information. The impracticality of his proposed method of compressing and decompressing the chamber is readily apparent. So, too, the likely toxic accumulation of carbon dioxide within the unventilated chamber during lengthy laborious periods required to operate it. Henshaw recommended pressures up to three times atmospheric pressure and durations for acute conditions until their resolution. Such exposures would likely result in fatal decompression sickness upon eventual chamber ascent, a condition of which nothing was known at the time. It would be another 170 years before a functional air chamber would finally become a reality. Henshaw's legacy, then, is limited to the concept of hyperbaric medicine rather than being its first practitioner.


Subject(s)
Hyperbaric Oxygenation , Hyperbaric Oxygenation/history , History, 19th Century , History, 20th Century , Atmosphere Exposure Chambers/history , Decompression Sickness/therapy , Decompression Sickness/history
3.
Undersea Hyperb Med ; 51(2): 185-187, 2024.
Article in English | MEDLINE | ID: mdl-38985154

ABSTRACT

A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.


Subject(s)
Aortic Dissection , Chest Pain , Decompression Sickness , Diving , Humans , Diving/adverse effects , Male , Middle Aged , Aortic Dissection/etiology , Aortic Dissection/diagnostic imaging , Aortic Dissection/complications , Aortic Dissection/surgery , Chest Pain/etiology , Decompression Sickness/etiology , Decompression Sickness/therapy , Decompression Sickness/complications , Decompression Sickness/diagnostic imaging , Decompression Sickness/diagnosis , Acute Disease , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/etiology , Aortic Aneurysm/complications , Aortic Aneurysm/surgery , Diagnosis, Differential
4.
Curr Sports Med Rep ; 23(5): 199-206, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38709946

ABSTRACT

ABSTRACT: Breath-hold divers, also known as freedivers, are at risk of specific injuries that are unique from those of surface swimmers and compressed air divers. Using peer-reviewed scientific research and expert opinion, we created a guide for medical providers managing breath-hold diving injuries in the field. Hypoxia induced by prolonged apnea and increased oxygen uptake can result in an impaired mental state that can manifest as involuntary movements or full loss of consciousness. Negative pressure barotrauma secondary to airspace collapse can lead to edema and/or hemorrhage. Positive pressure barotrauma secondary to overexpansion of airspaces can result in gas embolism or air entry into tissues and organs. Inert gas loading into tissues from prolonged deep dives or repetitive shallow dives with short surface intervals can lead to decompression sickness. Inert gas narcosis at depth is commonly described as an altered state similar to that experienced by compressed air divers. Asymptomatic cardiac arrhythmias are common during apnea, normally reversing shortly after normal ventilation resumes. The methods of glossopharyngeal breathing (insufflation and exsufflation) can add to the risk of pulmonary overinflation barotrauma or loss of consciousness from decreased cardiac preload. This guide also includes information for medical providers who are tasked with providing medical support at an organized breath-hold diving event with a list of suggested equipment to facilitate diagnosis and treatment outside of the hospital setting.


Subject(s)
Barotrauma , Breath Holding , Decompression Sickness , Diving , Humans , Diving/injuries , Diving/adverse effects , Barotrauma/etiology , Barotrauma/diagnosis , Decompression Sickness/therapy , Decompression Sickness/etiology , Decompression Sickness/diagnosis , Hypoxia/etiology , Inert Gas Narcosis/etiology , Inert Gas Narcosis/diagnosis
5.
Undersea Hyperb Med ; 50(4): 383-390, 2023.
Article in English | MEDLINE | ID: mdl-38055878

ABSTRACT

Introduction: The United States Navy (USN) developed and refined standardized oxygen treatment tables for diving injuries, but USN tables may not address all situations of spinal decompression sickness (DCS). We describe a detailed recompression treatment regimen that deviated from standard USN protocol for an active-duty USN diver with a severe, delayed presentation of spinal cord DCS. Case Report: A USN diver surfaced from his second of three dives on a standard Navy 'no-Decompression' Air SCUBA dive (Max depth 101 fsw utilizing a Navy Dive Computer) and developed mid-thoracic back pain, intense nausea, paresthesias of bilateral feet, and penile erection. Either not recognizing the con- stellation of symptoms as DCS and after resolution of the aforementioned symptoms, he completed the third planned dive (essentially an in-water recompression). Several hours later, he developed paresthesias and numbness of bilateral feet and legs and bowel incontinence. He presented for hyperbaric treatment twenty hours after surfacing from the final dive and was diagnosed with severe spinal DCS. Based on the severity of clinical presentation and delay to treatment, the initial and follow-on treatments were modified from standard USN protocol. MRI of the spine four days after initial presentation demonstrated a 2.2 cm lesion at the T4 vertebral level extending caudally. Follow-up examinations over two years demonstrated almost complete return of motor and sensory function; however, the patient continued to suffer fecal incontinence and demonstrated an abnormal post-void residual urinary volume. An atypical presenting symptom, a discussion of MRI findings, and clinical correlations to the syndrome of spinal DCS are discussed throughout treatment and long-term recovery of the patient.


Subject(s)
Decompression Sickness , Diving , Hyperbaric Oxygenation , Male , Humans , United States , Decompression Sickness/etiology , Decompression Sickness/therapy , Paresthesia/etiology , Paresthesia/therapy , Diving/adverse effects , Hyperbaric Oxygenation/methods , Laminectomy
6.
Undersea Hyperb Med ; 50(1): 57-64, 2023.
Article in English | MEDLINE | ID: mdl-36820807

ABSTRACT

This case report describes the successful management of an out-of-hospital arrest in a diver following a suspected arterial gas embolism (AGE). It illustrates both the inherent risks of diving and the importance of prompt and effective implementation of the "chain of survival" from bystanders. Rapid on-scene responses from paramedics and helicopter emergency medical services facilitated prompt evacuation to a Category 1 (multiplace) recompression chamber (RCC) where specialists in cardiology and hyperbaric medicine were available. Alternative causes of cardiac arrest were considered, with a presumed AGE successfully treated with multiple rounds of hyperbaric oxygen therapy. The key factors which led to this successful outcome are discussed, including early recognition and call for help, competent cardiopulmonary resuscitation, and direct evacuation to a Category 1 RCC, with additional consideration of the diagnosis leading to cardiac arrest. The case clearly illustrates the need for all those involved in diving regularly to be competent and confident in performing basic life support, as well as the awareness of the emergency services of the need for diving casualties to be treated at appropriate hyperbaric facilities. Were it not for the simple, prompt and effective treatment this diver received, both on scene and in hospital, it is highly unlikely that such a positive outcome would have been achieved.


Subject(s)
Carcinoma, Renal Cell , Cardiopulmonary Resuscitation , Decompression Sickness , Diving , Embolism, Air , Heart Arrest , Kidney Neoplasms , Out-of-Hospital Cardiac Arrest , Humans , Decompression Sickness/therapy , Carcinoma, Renal Cell/complications , Embolism, Air/etiology , Heart Arrest/complications , Kidney Neoplasms/complications , Out-of-Hospital Cardiac Arrest/complications
7.
Am J Emerg Med ; 59: 215.e7-215.e9, 2022 09.
Article in English | MEDLINE | ID: mdl-35718658

ABSTRACT

Survival of airplane stowaways is rare. Here we report an exceptional case of successful treatment and full recovery. After a transcontinental flight an unconscious stowaway was discovered in a wheel well of a Boeing 747-400F. Airport paramedics confirmed regular respiration and achieved 100% oxygen saturation (pulse oximetry) by high-flow oxygen. Rectal body temperature was 35.5 °C. On arrival at the emergency department, the patient's vital signs were stable. He did not respond to verbal stimuli. He localized to painful stimuli with both arms, however, there was no reaction to stimuli to both legs. We suspected his neurological deficits were caused by posthypoxic encephalopathy or altitude decompression sickness (DCS), the latter amenable to hyperbaric oxygen therapy (HBOT). HBOT was performed for 5 h (US Navy Treatment Table 6) and afterwards, full neurological recovery was documented. About 24 h after admission a new proximal paresis of the left leg was noted. Assuming recurrence of DCS, daily HBOT was scheduled for three days, after which motor function had again returned to normal. Stowaways travelling in airplane wheel wells experience extreme environmental circumstances. The presented patient survived an eight-hour exposure to calculated barometric pressures as low as 190 mmHg and ambient PO2 of 40 mmHg. Apart from creating awareness of this rare patient category, we want to stress the risk of altitude DCS in unpressurized flights. When DCS is suspected, immediate high-flow oxygen therapy should be initiated, followed by HBOT at the earliest opportunity.


Subject(s)
Aerospace Medicine , Altitude Sickness , Decompression Sickness , Hyperbaric Oxygenation , Aircraft , Altitude Sickness/complications , Decompression Sickness/diagnosis , Decompression Sickness/etiology , Decompression Sickness/therapy , Humans , Male , Oxygen
8.
Eur Heart J ; 42(16): 1545-1553, 2021 04 21.
Article in English | MEDLINE | ID: mdl-33507260

ABSTRACT

Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.


Subject(s)
Decompression Sickness , Foramen Ovale, Patent , Migraine Disorders , Thromboembolism , Decompression Sickness/therapy , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/therapy , Humans , Syndrome , Thromboembolism/etiology , Thromboembolism/prevention & control
9.
Undersea Hyperb Med ; 49(4): 507-518, 2022.
Article in English | MEDLINE | ID: mdl-36446296

ABSTRACT

Background: Early recompression therapy is suggested for a better clinical outcome of decompression sickness (DCS) patients. This study analyzed the efficacy of our 24-hour on-call system for early recompression therapy. Methods: We conducted a single-center retrospective cohort study. They were classified into DCS Type I versus Type II, duty time versus non-duty time groups based on the time of emergency department (ED) admission, and hospitalization versus discharge groups according to clinical outcomes. Baseline characteristics, diving variables, and in-hospital course were analyzed. Results: This study investigated 341 acute DCS patients. A total of 81 and 260 patients had Type I and Type II DCS, respectively. While 198 patients accessed the center during duty time, 143 presented during non-duty time. Fifty patients were admitted, and 291 patients were discharged. Total median time from symptom onset to HBO2 therapy was 259 minutes: 240 minutes for the duty group and 292 minutes for the non-duty group (p=0.16); 251 minutes for the discharged group and 291 minutes for the hospitalized group (p<0.001). The median time from ED admission to HBO2 therapy was 65 minutes: 60 minutes for the duty group and 69 minutes for the non-duty group (p=0.23); 63.4 minutes for the discharged group and 92 minutes for the hospitalized group (p=0.05). Conclusion: The 24-hour on-call system was able to provide acute DCS patients with early recompression therapy even during non-duty time. However, in terms of the outcome of treatment of patients, quicker arrival at the hospital and swifter recompression therapy are needed.


Subject(s)
Decompression Sickness , Diving , Humans , Decompression Sickness/therapy , Retrospective Studies , Secondary Prevention , Hospitalization
10.
Nursing ; 52(6): 32-34, 2022 Jun 01.
Article in English | MEDLINE | ID: mdl-35609074

ABSTRACT

ABSTRACT: There are approximately 2.8 million active self-contained underwater breathing apparatus (SCUBA) divers in the US who are at risk for decompression sickness. This article discusses the pathophysiology, common signs and symptoms, and treatments of this multisystem complication of SCUBA diving.


Subject(s)
Decompression Sickness , Diving , Decompression Sickness/etiology , Decompression Sickness/therapy , Diving/adverse effects , Diving/physiology , Humans , Personal Protective Equipment
11.
Med Lav ; 113(4): e2022034, 2022 Aug 25.
Article in English | MEDLINE | ID: mdl-36006094

ABSTRACT

BACKGROUND: Dysbaric osteonecrosis (DON) is defined as avascular bone necrosis, usually involving specific parts of the long bones, which is seen in divers or compressed-air workers due to exposure to pressure. We describe a case of DON in an artisanal diving fisherman working underwater for many years. Methods: A 48-year-old male case was admitted to the occupational disease outpatient with left shoulder and arm pain for 1-2 years. Since the age of 20, he has been artisanal diving fishing with a hookah at a depth of 20-25 meters in the sea. In 2011, he received hyperbaric oxygen therapy for widespread pain in the whole body due to decompression sickness (DCS). In the case's left shoulder joint x-ray and magnetic resonance imaging, degenerative changes in the acromioclavicular joint and signal changes consistent with osteonecrosis starting from the subcortical area of the humeral head and extending to the proximal shaft of the humerus were observed. Conclusions: DON is among the most common long-term pathologies in professional divers. In Turkey, as in our case, not applying safe decompression procedures and unsafe diving practices are common among diving fishers. In studies, the frequency of exposure to pressure, duration and depth of dive, insufficient decompression, formation of DCS and increasing age were associated with DON. Today, DON remains an occupational hazard with significant medical and social consequences. Diving fishers should be informed about the sequelae of DCS and trained on the safety measures to be taken.


Subject(s)
Decompression Sickness , Diving , Occupational Diseases , Osteonecrosis , Decompression Sickness/complications , Decompression Sickness/therapy , Diving/adverse effects , Humans , Male , Occupational Diseases/etiology , Osteonecrosis/complications , Pain/complications
12.
Undersea Hyperb Med ; 48(4): 443-448, 2021.
Article in English | MEDLINE | ID: mdl-34847308

ABSTRACT

Inner ear decompression sickness (IEDCS) is a rare diving complication that presents with vestibular dysfunction, cochlear dysfunction, or a combination of both. While scuba diving is a known cause, no cases have been reported in the occupational hyperbaric setting. We present the case of a 55-year-old man who developed IEDCS after working as a hyperbaric multiplace chamber inside tender. The patient was treated with seven sessions of hyperbaric oxygen therapy, resulting in resolution of the majority of his symptoms. This case illustrates a potential occupational hazard of working in a hyperbaric chamber and demonstrates successful treatment with hyperbaric oxygen therapy.


Subject(s)
Decompression Sickness , Diving , Ear, Inner , Hyperbaric Oxygenation , Decompression Sickness/etiology , Decompression Sickness/therapy , Diving/adverse effects , Humans , Male , Middle Aged
13.
Undersea Hyperb Med ; 48(2): 195-203, 2021.
Article in English | MEDLINE | ID: mdl-33975411

ABSTRACT

Decompression sickness (DCS, "bends") is caused by formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during any of the following: ascent from a dive; depressurization of a hyperbaric chamber; rapid ascent to altitude in an unpressurized aircraft or hypobaric chamber; loss of cabin pressure in an aircraft; and during space walks.


Subject(s)
Decompression Sickness/therapy , Diving/adverse effects , Hyperbaric Oxygenation/methods , Altitude , Decompression Sickness/etiology , Diving/injuries , First Aid/methods , Humans , Time-to-Treatment
14.
Undersea Hyperb Med ; 48(1): 25-31, 2021.
Article in English | MEDLINE | ID: mdl-33648030

ABSTRACT

Background: The treatment of decompression sickness (DCS) with hyperbaric oxygen (HBO2) serves to decrease intravascular bubble size, increase oxygen (O2) delivery to tissue and enhance the elimination of inert gas. Emulsified perfluorocarbons (PFC) combined with breathing O2 have been shown to have similar effects animal models. We studied an ovine model of severe DCS treated with the intravenous PFC Oxycyte™ while breathing O2 compared to saline control also breathing O2. Methods: Juvenile male sheep (N=67; weight 24.4±2.10kg) were compressed to 257 feet of sea water (fsw) in our multiple large-animal chamber where they remained under pressure for 31 minutes. Animals then were decompressed to surface pressure and randomized to receive either Oxycyte at 5mL/kg intravenously (IV) or 5mL/kg saline IV (both receiving 100% O2) 10 minutes after reaching surface pressure. Mortality was recorded at two hours, four hours, and 24 hours after receiving the study drug. Surviving animals underwent perfusion fixation and harvesting of the spinal cord at 24 hours. Spinal cord sections were assessed for volume of lesion area and compared. Results: There was no significant difference in survival at two hours (p=0.2737), four hours (p=0.2101), or 24 hours (p=0.3171). Paralysis at 24 hours was not significantly different. However, spinal cord lesion area was significantly smaller in the Oxycyte group as compared to the saline group, with median spinal cord lesion areas 0.65% vs. 0.94% (p=0.0107). Conclusion: In this ovine model of severe DCS the intravenous PFC Oxycyte did not reduce mortality but did ameliorate spinal cord injury when used after the onset of DCS.


Subject(s)
Decompression Sickness/therapy , Fluorocarbons/therapeutic use , Oxygen Inhalation Therapy/methods , Spinal Cord Injuries/prevention & control , Animals , Decompression Sickness/complications , Decompression Sickness/mortality , Disease Models, Animal , Fluorocarbons/administration & dosage , Injections, Intravenous , Male , Paralysis/etiology , Random Allocation , Saline Solution/administration & dosage , Seawater , Sheep , Spinal Cord Injuries/pathology , Time Factors
15.
Wilderness Environ Med ; 32(1): 70-73, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33309396

ABSTRACT

A 26-y-old experienced scotoma scintillans after 59 min of scuba diving at a maximum depth of 26 m. After the patient smoked a cigarette, the scotoma scintillans ceased. However, he then developed a headache, general fatigue, and shoulder and elbow pain. He therefore called an ambulance. Based on the rules of the medical cooperative system for decompression sickness in Izu Peninsula, the fire department called a physician-staffed helicopter. After a physician checked the patient, his complaints remained aside from a low-grade fever. A portable ultrasound revealed bubbles in his inferior vena cava. Because of the risk of his being infected with COVID-19, he was transported to our hospital not by air evacuation but via ground ambulance staff while receiving a drip infusion of fluid and oxygen. After arriving at the hospital, his symptoms had almost subsided. Whole-body computed tomography revealed gas around the bladder, left hip, right knee, bilateral shoulder, joints, and right intramedullary humerus. The patient received high-concentration oxygen, infusion therapy, and observational admission. On the second day of admission, his symptoms had completely disappeared, and he was discharged. To our knowledge, this is the first report that computed tomography might be useful for detecting gas in multiple joints, suggesting the onset of decompression sickness after diving. This might be the first report of gas in an intramedullary space after diving as a potential cause of dysbaric osteonecrosis.


Subject(s)
Decompression Sickness/diagnostic imaging , Diving/adverse effects , Gases/metabolism , Joints/diagnostic imaging , Tomography, X-Ray Computed , Adult , Decompression Sickness/etiology , Decompression Sickness/pathology , Decompression Sickness/therapy , Humans , Joints/metabolism , Male , Oxygen/administration & dosage , Treatment Outcome
16.
J UOEH ; 43(2): 243-254, 2021.
Article in Japanese | MEDLINE | ID: mdl-34092769

ABSTRACT

Decompression illness (DCI), a syndrome following inadequate reduction in environmental pressure, has two forms: decompression sickness and arterial gas embolism after pulmonary barotrauma. Recompression therapy using oxygen, a kind of hyperbaric oxygen therapy, has been considered the gold standard treatment for DCI, although there is no randomized controlled trial evidence for its use. We evaluated the effectiveness of recompression therapy in treating DCI by reviewing the reported therapeutic results of serious DCI, especially neurological disorders. Early or ultra-early recompression therapy did not dramatically improve clinical recovery from DCI symptoms, including spinal cord disorders. In contrast, early first aid normobaric oxygen inhalation highly improved or stabilized clinical conditions of DCI. Based on these clinical results, the international committee for hyperbaric and diving medicine has stated that cases of mild DCI may be managed without recompression therapy. Further work is needed to clarify the clinical utility of recompression therapy for spinal injury as a common symptom of DCI. We also point out that the Japanese decree "Ordinance on Safety and Health of Work under High Pressure", which describes work under hyperbaric environments, has some serious issues and should be amended on the basis of scientific evidence.


Subject(s)
Decompression Sickness , Hyperbaric Oxygenation , Decompression , Decompression Sickness/therapy , First Aid , Humans , Oxygen
17.
J UOEH ; 43(1): 87-96, 2021.
Article in Japanese | MEDLINE | ID: mdl-33678790

ABSTRACT

Hyperbaric medicine includes two different medical fields: hyperbaric oxygenation (HBO) as emergency and intensive care, and diving medicine. Recent topics in hyperbaric therapy include radiation oncology and regenerative medicine. Of special interest are clinical studies of radiotherapy after HBO that were conducted at some institutes to evaluate its therapeutic effects for cancer patients. A few studies have shown that HBO improves memory disturbance following traumatic brain injury and hypoxic and ischemic events. There is a great possibility that HBO enhances the therapeutic effects of radiotherapy and potentiates regenerative medicine. Randomized controlled trials, however, have indicated the re-examination of its viable treatment effects in some conditions, including decompression illness, carbon monoxide poisoning, and serious soft tissue infection. As recent trends in the treatment of decompression illness have changed on the basis of clinical series, the laws related to diving and caisson work should be amended in the future.


Subject(s)
Forecasting , Hyperbaric Oxygenation/methods , Hyperbaric Oxygenation/trends , Neoplasms/therapy , Brain Injuries/complications , Carbon Monoxide Poisoning/therapy , Decompression Sickness/therapy , Humans , Memory Disorders/etiology , Memory Disorders/therapy , Radiation Oncology , Regenerative Medicine
18.
Article in Zh | MEDLINE | ID: mdl-34074084

ABSTRACT

Objective: To discuss the new idea of on-the-spot recompression treatment and multidisciplinary treatment (MDT) for patients with unstable vital signs of type II decompression sickness. To provide reference for the nearby treatment of patients with critical decompression sickness. Methods: The clinical data of a case of a multi-disciplinary collaborative treatment of type II decompression sickness complicated with multiple organ dysfunction syndrome (MODS) admitted to a third-class A hospital in January 2020 were analyzed and summarized. Results: The patient suffered from consciousness disturbance and shock after 3 min of diver's blow-up out of the water. CT examination showed gas accumulation in the systemic multi-organ venous system, and laboratory examination suggested MODS. The oxygen inhalation regimen was given in the session of recompression treatmen by 0.12-0.18 MPa. Intravenous fluid was the total of 8900 ml in the session, and the total recompression treatment time was 9 h 45 min. The patient was still in unconscious when he finished the session. CT re-examination confirmed the elimination of venous bubbles, and laboratory examination indicated multiple organ failure (MOF) . The patient was given comprehensive supporting treatment by mechanical assisted breathing and following by continuons renal replacement therapy (CRRT) and extrocorporeal membrane oxygenation (ECMO) in the intensive care unit, and was discharged after 32 d of hospitalization. Conclusion: Critical decompression sickness patients with unstable vital signs are taken to a local general hospital with hyperbaric oxygen chamber and intensive care unit. The successful treatment can be achieved by organizing diving medicine, hyperbaric oxygen medicine and critical medical personnel for MDT.


Subject(s)
Continuous Renal Replacement Therapy , Decompression Sickness , Diving , Extracorporeal Membrane Oxygenation , Hyperbaric Oxygenation , Decompression Sickness/complications , Decompression Sickness/therapy , Humans , Multiple Organ Failure/therapy
19.
Undersea Hyperb Med ; 47(4): 551-554, 2020.
Article in English | MEDLINE | ID: mdl-33227830

ABSTRACT

With the increasing popularity of recreational scuba diving, rare complications are becoming more commonly encountered. Although diving is generally safe, novice divers may be unfamiliar with the potential hazards of scuba diving and the resulting sequelae. Dive-related injuries are commonly due to barotrauma or from breathing gas at increased pressures, resulting in decompression illness (DCI), a term that includes both decompression sickness (DCS) and arterial gas embolism (AGE). Symptoms can range from minor aches and pains to neurologic or cardiopulmonary complications resulting in death. Clinical symptoms and diagnosis may initially go unrecognized and can present in a delayed manner, often remote to the diving location. When DCI is suspected standard treatment with hyperbaric oxygen (HBO2) therapy should be considered immediately. Current literature questions the efficacy of delayed HBO2 therapy longer than 24-48 hours after symptom onset. Here we present a case of two divers who simultaneously experienced DCS and were both successfully treated after receiving delayed HBO2 therapy nearly eight days after initiation of symptoms.


Subject(s)
Decompression Sickness/therapy , Hyperbaric Oxygenation , Time-to-Treatment , Humans , Male , Time Factors , Young Adult
20.
Undersea Hyperb Med ; 47(2): 203-210, 2020.
Article in English | MEDLINE | ID: mdl-32574436

ABSTRACT

Simulated flight in a hypobaric chamber is a fundamental component in the physiological training of aviators. Although rare, there is always a risk of decompression sickness (DCS) in trainees during hypobaric hypoxia training. In this study we aimed to determine the incidence of altitude-induced DCS and the symptoms manifested in trainees and inside chamber observers (ICOs) during the training sessions. We retrospectively reviewed the records of DCS cases during the period of January 1, 2011, and October 1, 2018. The records of 6,657 trainees and 615 ICOs were evaluated. The gender distribution in 6,657 trainees was 6,578 (98.81%) male and 79 (1.19%) female. The numbers of DCS cases in trainees and ICOs were six (0.09%) and two (0.33%), respectively [(ICOs versus trainees - odds ratio (OR): 3.574; 95% CI 0.720-17.744; (p > 0.05)]. All ICOs were male; no DCS incident was observed among female trainees. Recompression treatments were applied on site, and complete recovery was achieved in all cases. Overall DCS incidence was found to be 0.11% among the 7,193 male subjects, which included trainees and ICOs. The higher incidence of DCS in ICOs was attributed to the physical activities performed at altitudes by ICOs. In such training, established instructions have to be strictly followed by physicians, ICOs and trainees. All trainees and ICOs should be aware of the symptoms and signs of DCS, and medical support including a recompression facility, should be provided on site during hypobaric hypoxia training.


Subject(s)
Altitude Sickness/complications , Decompression Sickness/epidemiology , Hypoxia/complications , Simulation Training/methods , Decompression Sickness/therapy , Female , Humans , Incidence , Male , Military Personnel , Odds Ratio , Retrospective Studies , Sex Distribution , Simulation Training/statistics & numerical data
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