Scuba diving-related fatalities in the Philippines from 2008 to 2022 as reported in online news media.

The present study aims to investigate the demographics and characteristics of scuba diving fatalities in the Philippines which can help in the identification of local trends and ultimately in the development of appropriate preventive measures. Data on scuba diving-related fatalities in the Philippines from 2008 to 2022 were manually retrieved from online news media sources. Information on age, sex, nationality, certification, purpose, and causative factors, whenever possible were collected and analysed. A total of 39 fatalities were identified having a median age of 43.5 (range 20-80). Majority of victims were males (n = 30), and of foreign ethnicity (n = 26). Asphyxia was identified as the possible disabling injury in almost half of the cases (n = 17). The causes of death based on autopsies were determined only for few cases which included drowning (n = 2), heart attack (n = 1), and traumatic injuries from a dynamite blast (n = 1). Potential vulnerable groups were identified to be the ageing population and foreign tourist divers. In the absence of an existing database, this preliminary report provides the best available evidence at this time concerning scuba diving fatalities in the Philippines.

Underwater and Scuba Diving Accidents.

The evaluation and care of an injured scuba diver requires an understanding of the different types of underwater activities that may be deemed scuba diving. Such activities may range from the complex (eg, commercial or technical diving) all the way up to basic recreational scuba or snorkeling. A thorough physical examination should be completed as early as possible with a focus on specific areas at risk for injury and etiology, such as a detailed cardiopulmonary, skin, and neurologic examination. Serial reassessments and supportive care are as equally important as consultation with a dive medicine expert, especially one with hyperbaric capabilities.

Breath-Hold Diving Injuries - A Primer for Medical Providers.

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.

Dive Hazards: Barotrauma, Flora, Fauna, Equipment, and Free Diving.

ABSTRACT: Present-day diving comes in various forms, from utilizing sophisticated diving equipment to relying solely on one's ability to hold their breath. The diver and physician must be aware of the many common medical conditions and environmental considerations of this unique activity. While barotrauma remains the most common dive-related injury, injuries and accidents also are related to diving equipment-related accidents and exposure to marine flora and fauna. In addition, breath-hold diving, which includes free diving, snorkeling, and tasks, is an activity humans have done for thousands of years for recreation or survival. This article will update the dangers of diving and methods to prevent or treat injuries.

Chain of events analysis in diving accidents treated by the Royal Netherlands Navy 1966-2023.

Introduction: Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries is limited. A previously published 'chain of events analysis' (CEA) framework consists of five steps that may sequentially lead to a diving fatality. This study applied four of these steps to predominately non-lethal diving injuries and aims to determine the causes of diving injuries sustained by divers treated by the Diving Medical Centre of the Royal Netherlands Navy. Methods: This retrospective cohort study was performed on diving injuries treated by the Diving Medical Centre between 1966 and 2023. Baseline characteristics and information pertinent to all four steps of the reduced CEA model were extracted and recorded in a database. Results: A total of 288 cases met the inclusion criteria. In 111 cases, all four steps of the CEA model could be applied. Predisposing factors were identified in 261 (90%) cases, triggers in 142 (49%), disabling agents in 195 (68%), and 228 (79%) contained a (possible-) disabling condition. The sustained diving injury led to a fatality in seven cases (2%). The most frequent predisposing factor was health conditions (58%). Exertion (19%), primary diver errors (18%), and faulty equipment (17%) were the most frequently identified triggers. The ascent was the most frequent disabling agent (52%). Conclusions: The CEA framework was found to be a valuable tool in this analysis. Health factors present before diving were identified as the most frequent predisposing factors. Arterial gas emboli were the most lethal injury mechanism.

Odontocrexis / Odontocrexis / Odontocrexis

Los cambios en la presión atmosférica pueden ocasionar patología odontológica en personas que presentan dientes con caries, obturaciones deficientes o temporales y en todas aquellas lesiones cavitadas donde puedan quedar albergadas burbujas de aire.Se presenta el caso clínico de un buceador de la Armada Española que acude al servicio de odontología de la Jefatura de Apoyo Sanitario del Arsenal de Cartagena, por presentar fractura dental completa, “odontocrexis”, derivado de la expansión volumétrica de los gases en el ascenso a la superficie terrestre durante la realización de un ejercicio de buceo militar. (AU)

Changes in atmospheric pressure can cause dental disease in people with decayed teeth, poor or temporary fillings, and in all cavitated lesions where air bubbles can be lodged.The clinical case of a diver from the Spanish Navy who attends the dentistry service of the Sanitary Support Headquarters of the Cartagena Arsenal is presented, due to presenting a complete dental fracture, “odontocrexis”, derived from the volumetric expansion of the gases during the ascent to the ground during a military diving exercise. (AU)

Mudanças na pressão atmosférica podem causar patologia dentária em pessoas com dentes cariados, obturações deficientes ou temporárias e em todas as lesões cavitadas onde bolhas de ar podem se alojar.É apresentado o caso clínico de um mergulhador da Marinha Espanhola que frequenta o serviço de odontologia do Quartel de Apoio Sanitário do Arsenal de Cartagena, por apresentar uma fratura dentária completa, “odontocrexia”, decorrente da expansão volumétrica dos gases durante a subida ao solo durante um exercício de mergulho militar. (AU)

Osteonecrosis disbárica de cabeza humeral en buzo pesquero tratado con artroplastia de superficie / Dysbaric osteonecrosis of humeral head in a diver treated with resurfacing arthroplasty

Describir osteonecrosis disbárica (ODB) en buzo pesquero y exponer la experiencia inédita de tratamiento con artroplastia de superficie (AS). Introducción ODB, forma de necrosis avascular secundaria a enfermedad por descompresión (EDC), cuyo tratamiento gold standard para estadios avanzados continúa siendo la artroplastia total (AT). Presentación de caso: Paciente de 49 años, buzo pesquero, antecedentes de EDC tratada el 2008 en cámara hiperbárica, con diagnóstico compatible con ODB de cabeza humeral derecha de 6 años de evolución; Constant score=29. Se realiza AS del hombro derecho, y luego de 18 meses de seguimiento se reporta una adecuada evolución clínica con remisión de la sintomatología; Constant score a 18 meses=72. Discusión: El uso de AT en el paciente joven es limitado, por lo que surge la necesidad de implementar nuevas técnicas quirúrgicas en este grupo de pacientes. Conclusión: La AS constituye una alternativa terapéutica en adultos jóvenes y activos con ODB...

Introduce and describe Dysbaric Osteonecrosis (DON) in a fishing diver patient, emphasising clinical features, use of imaging methods, and present a new experience of treatment with Resurfacing Arthroplasty (RA). Introduction: DON, a form of avascular necrosis secondary to Decompression Sickness (DCS). Total Arthroplasty (AT) remains the reference treatment for advanced stages. Case report: Male, 49 years old, fishing diver, with a history of DCS treated in a hyperbaric chamber (2008). Right humeral head DON Compatible with 6 years of onset. Constant Score=29. RA performed on right shoulder. Clinical remission of symptoms was observed after 18 months of follow-up. Constant Score at 18 months=72. Discussion: TA use in young patients is limited, so there is a need to implement new surgical techniques in this group of patients. Conclusion: RA is a therapeutic alternative in young and active subjects with DON...

Muerte por sumersión debida a shallow water blackout / Death due to drowning by shallow water blackout

El llamado shallow water blackout, o síncope de las aguas superficiales, es un accidente que pueden sufrir los buceadores y llevarles a la muerte por sumersión. La natación sumergido (buceando) precedida de hiperventilación crea una situación en la que el sujeto puede sufrir hipoxia antes de que la concentración en sangre arterial de dióxido de carbono alcance el nivel que le obligue a salir a la superficie a respirar. En esta situación, el sujeto inconsciente puederespirar bajo el agua y morir por sumersión (AU)

We report a case of drowning due to shallow water blackout. This happens when divers deliberately hyperventilate and then enters the water to see how long they can stay submerged or how far they can swim underwater. In this situation the PaO2 may fall to a level sufficient to cause loss of consciousness before de PaCO2 has risen enough to trigger ventilation. Once they lose consciousness they drive to breathe and inhale water, thus initiating the drowning process (AU)

Efectos tóxicos y manejo de las lesiones provocadas por el pez león (Pteroisvolitans, P. miles) / Toxic effects and management and injuries caused by the lion fish(Pteroisvolitan, P. miles)

El Pez León (Pterois volitans y Pteroismiles), especie registrada como invasora en el Atlántico occidental; se ha constituido en un poderoso depredador gracias a que no tiene un antagonista natural en la segunda barrera coralina más grande del mundo, poniendo en riesgo a las especies marinas endémicas de la zona, así com o a nadadores, buzos recreativos, comerciales y pescadores que entran en contacto con el pez. El pinchazo del pez león es venenoso, tiene aproximadamente 17 espinas dorsales,pélvicas y anal, cada uno contiene un tubo que se conecta al extremo de una glándula venenosa que segrega 3 a 10mg de veneno por espina. El mecanismo de intoxicación se produce cuando la persona pisa o toca al pez, ejerciendo presión sobre las espinas y al penetrar la piel las glándulas venenosas liberan el veneno. La toxina inoculada puede causar dolor intenso, fiebre, parálisis respiratoria humana e insuficiencia circulatoria. La toxicidad del veneno es debida a antigénicos de proteínas de alto peso molecular. El tratamiento se basa en la termolabilidad de dichas proteínas, bloquear la respuesta inflamatoria sistémica y las posibles complicaciones. Con esta revisión bibliográfica se pretende ampliar sobre los efectos tóxicos y el manejo de las lesiones provocadas por el pez león, a fin de informar a la comunidad médica hondureña de los problemas de salud causada...

Barotrauma ocular durante mergulho autônomo / Ocular barotrauma during scuba diving

Relato de um caso de barotrauma ocular bilateral relacionado ao mergulho autônomo, com hemorragia conjuntival e periocular. Alguns conceitos de física e cuidados durante o mergulho são reportados para um melhor entendimento da fisiopatogenia do quadro, de modo que se possa melhor orientar os pacientes quanto à prevenção.

Report of a case of bilateral ocular barotrauma related to scuba diving, with conjunctival and periocular hemorrhage. Some concepts about Physics and caution are provided to better understanding the pathophysiology of the barotrauma, so proper orientation regarding prevention might be provided.

Enfermedades del oído externo y la articulación temporomandibular en el buceo / Alterations of the external ear and temporomandibular joint in diving

La práctica del buceo ha experimentado un notable crecimiento en las últimas décadas. Una amplia mayoría de las enfermedades asociadas con ella están relacionadas con el área de la cabeza y el cuello, por lo que un otorrinolaringólogo debe conocer los problemas que un buceador puede experimentar. En el oído externo destacan enfermedades como la otitis externa difusa, los barotraumatismos y la exostosis. También, con alta prevalencia, se presenta en los buceadores el síndrome de disfunción de la articulación temporomandibular (AU)

The practice of diving has experienced marked growth in the last few decades. Most of the disorders associated with this activity are related to the head and neck and consequently otorhinolaryngologists should be familiar with the problems that divers can experience. Notable among disorders of the external ear are diffuse otitis externa, barotrauma, and exostosis. Temporomandibular joint dysfunction syndrome is also highly prevalent among divers (AU)

Enfermedades del oído medio en el buceo y la aviación. Barotraumas / lterations of the middle ear in diving and flying. Barotrauma

Los barotraumas de oído medio son las afecciones más frecuentes en el mundo del buceo y la aviación. Hablaremos de su localización y etiología. Comentaremos la relación con el mal funcionamiento de la trompa de Eustaquio y sus factores predisponentes. Destacaremos la clínica y la clasificación lesional en función de la exploración otoscópica. Los disbarismos crónicos, mucho menos prevalentes, se presentan tras exposiciones repetidas a medios hipobáricos-hiperbáricos. El diagnóstico se hace habitualmente mediante otoscopia y valoraremos el tratamiento de las lesiones barotraumáticas del oído medio en función de su clasificación lesional (AU)

Barotrauma of the middle ear are the most frequent injuries in diving and flying. The present article discusses the location and etiology of these lesions. The association with poor Eustachian tube function and its triggering factors are discussed. Emphasis is placed on the symptoms and classification of lesions according to otoscopic examination. Chronic dysbarisms, which are much less prevalent, develop after repeated exposure to hypobaric-hyperbaric environments. Diagnosis is usually established through otoscopy. Treatment of barotrauma of the middle ear is evaluated according to the type of lesion (AU)

Toxicidad pulmonar asociada al empleo de oxígeno hiperbárico: procedimientos de cálculo / Pulmonary toxicity is associated with the hyperbaric oxygen: methods of calculation

OBJETIVOS: Estudiar si una exposición hiperbárica de larga duración motivada por la aparición de una enfermedad descompresiva bajo presión, presenta alteraciones espirométricas y si éstas están acompañadas de sintomatología clínica pulmonar compatible con toxicidad pulmonar por oxígeno. PACIENTES Y MÉTODO: 3 buceadores profesionales que durante una inmersión a 100 metros de profundidad, uno de ellos presenta, antes de terminar la inmersión una patología descompresiva que requiere aumentar los tiempos de respiración de oxígeno, se realizan espirometrías pre- y post-inmersión midiendo: FVC, FEV1, PEF, FEV1/FVC, FEF25-75, FEF 75-85, FEF 25, FEF 50, FEF 75. RESULTADOS: Los resultados post-inmersión demuestran un descenso global de todos los parámetros estudiados destacando el descenso de PEF (12.8%), FEF 50 (9,3%) y FEV1 (8.8%), de forma individual 2 buceadores mostraron descenso de todos los parámetros mientras que un buceador de los nueve parámetros estudiados solo experimentó descenso en cinco. Estos resultados no estuvieron acompañados de sintomatología pulmonar y carecieron de significado estadístico. CONCLUSIONES: Tras esta exposición hiperbárica se alteró el flujo y la capacidad sin la presencia de sintomatología clínica pulmonar y papel importante de la susceptibilidad individual. Los estudios de función pulmonar se deberían extender a colectivos sometidos a: cambios constantes de presión y a la respiración de oxígeno, gas con efectos tóxicos agudos y a largo plazo (AU)

INTRODUCTION: We studied if one hyperbaric exposition in the long term with decompression sickness under pressure causes disturbances in the pulmonary functions and if they are related with clinical manifestations which are compatibles with pulmonary oxygen toxicity. PATIENTS AND METHOD.-Three professional divers carried out one immersion at 100 meters of deep, only one person displayed, before the immersion was finished, one decompression pathology which need increase the times breathing of oxygen, we valued the pulmonary functions pre and post immersion so we measured: FVC, FEV1, PEF, FEV1/FVC, FEF25-75, FEF 75-85, FEF 25, FEF 50 and FEF 75. RESULTS: The post immersion results showed one total decline of all studied parameters showed the decrease of PEF (12.8%), FEF 50 (9.3%) and FEV1 (8.8%), two divers showed one decline of all parameters meanwhile that one diver registered decrease only in five parameters. These results are not accompanied of pulmonary symptoms and of significant statistic. CONCLUSIONS: After this hyperbaric exposure, the flow and the capacity were disturbed but they did not show neither clinic pulmonary symptoms nor had one important role in the personal susceptibility. The studies of pulmonary function should include group with constant pressure changes and the breathing of oxygen, this gas have acute toxic effects in the long term (AU)

Simulacro de emergencia: Rescate y atención de una víctima en actividades submarinas / A shan of emergency: Rescue and service to victims in submarine activities

Simulacro en el que se representó el rescate y atención de una víctima de buceo deportivo en mar abierto, con el objetivo de evaluar la coordinación de actividades y comunicaciones.(AU)

Lesiones por buceo / Injuries by diving

Principales patologías de la medicina del buceo, su diagnóstico y tratamiento.(AU)

Patologias otorrinolaringológicas relacionadas com o trabalho de mergulho / Otorhinolaryngological diseases related to the work of diving

Apesar da grande variabilidade dos ecossistemas, evoluimos em um ambiente cuja pressão atmosférica está em torno de uma atmosfera absoluta de pressão. Alterações significativas desta pressão atmosférica podem causar lesões ao organismo humano que precisam ser bem conduzidas. A quantidade e a profundidade dos mergulhos profissionais e recreativos têm aumentado, exigindo o mesmo no conhecimento das eventuais alterações causadas pelo ambiente hiperbárico. Nesta pesquisa teórica, busca-se caracterizar as alterações otorrinolaringológicas decorrentes de mergulho, detalhando-se o quadro clínico e a terapêutica. Estuda também a prevenção e controle de patologias no mergulho, onde o médico do trabalho tem papel fundamental, examinando, orientando os trabalhadores em atividades insalubres em grau máximo, de acordo com o anexo 6 da Norma Regulamentadora 15 (item 1 - Trabalho sob ar comprimido e item 2 - Trabalhos submersos). Devido à expansão das atividades subaquáticas, o conhecimento da fisiopatologia, asssim como das consequencias e da conduta nas complicações otorrinolaringológicas devidas ao mergulho devem ser de conhecimento de todos os especialistas em otorrinolaringologia e médicos do trabalho.

Barotrauma pulmonar en joven buceador / Pulmonary barotrauma in young diver

La mayoría de las lesiones en buceo están relacionadas con el comportamiento de gases y presiones durante el descenso y ascenso. Las cuatro principales patologías en Medicina de buceo incluyen: barotrauma (sinusal, ótico y pulmonar); enfermedad por descompresión; edema pulmonar y efectos tóxicos y farmacológicos de presiones parciales de gases aumentadas. Las manifestaciones clínicas de una lesión de buceo pueden aparecer durante una zambullida y hasta 24 horas después de ella. Los médicos que viven lejos de zonas donde se bucea no están excluidos de la posibilidad de encontrarse pacientes con lesiones de buceo y por lo tanto deben estar al tanto de estas lesiones. Describimos un caso clínico de un joven buceador que sufrió un barotrauma pulmonar después de una secuencia de inmersiones libres a 5 metros y sugerimos un posible mecanismo (AU)

Most diving injuries are related to the behaviour of the gases and pressure changes during descent and ascent. The four main pathologies in diving medicine include: barotrauma (sinus, otic, and pulmonary); decompression illness; pulmonary edema and pharmacological and toxic effects of increased partial pressures of gases. The clinical manifestations of a diving injury may be seen during a dive or up to 24 h after it. Physicians living far away from diving places are not excluded from the possibility of encountering diver-injured patients and therefore need to be aware of these injuries. We report a case of a young diver who suffered an episode of pulmonary barotrauma after a sequence of free divers to five metres, and suggest a possible mechanism (AU)

Osteomielitis por Pseudomonas aeruginosa en un submarinista / Osteomyelitis by Pseudomonas aeruginosa in a submariner

No disponible

Mergulho em águas rasas e lesão medular: uma abordagem educativa e preventiva / Diving in shallow waters and spinal cord injury: a preventive and educational approach

Este artigo tem como objetivo revisar estudos envolvendo acidentes por mergulho e lesão medular. A existência de poucos dados na literatura brasileira sobre este assunto motivaram a pesquisa. O método utilizado foi à revisão bibliográfica (MEDLINE, LILACS), selecionando aspectos sobre prevenção de lesão medular e mergulho, educação, e medidas preventivas. Concluiu-se que a lesão medular causada por mergulho em águas rasas tem uma incidência elevada no mundo principalmente no período do verão. Ocorre em indivíduos jovens, sadios, geralmente sexo masculino apresentando uma forte associação com uso de álcool. Medidas preventivas, educativas são primordiais para a diminuição de novos casos.