SARS-COV-2 (COVID-19) y buceo: reconocimiento médico postinfección y retorno al buceo / SARS-CoV-2 (COVID-19) and diving: post-infection medical checkup and return to diving

La práctica del buceo expone al buceador a un medio en el que tanto el aumento de la presión ambiental como las exigencias físicas pueden favorecer la aparición de una serie de patologías que se pueden agravar por el mal estado físico del buceador. La infección por SARS-COV-2 (COVID-19) tiene entre otros, consecuencias pulmonares, cardiacas, hematológicas e incluso limitación de la capacidad física. Derivado de lo anterior se hace necesario un reconocimiento médico adicional de todo aquel buceador o personal de sanidad con antecedentes de infección por SARS-COV-2 y que se vaya a exponer a un ambiente hiperbárico. La IT 02/16 de IGESAN y sobre todo su ampliación el 8 de febrero de 2021, establece un protocolo de actuación ante estas situaciones. (AU)

Diving exposes the diver to an environment in which both the increased environmental pressure and the physical demands can favor the appearance of a series of pathologies that can be aggravated by the diver's poor physical condition. SARS-COV-2 (COVID-19) infection has, among others, pulmonary, cardiac, hematological consequences and even physical capacity limitations. As a result of the above, a medical examination of any diver or healthcare personnel with a history of SARS-COV-2 infection who is going to be exposed to a hyperbaric environment is necessary. The IT 02/16 of IGESAN and especially its extension on February 8, 2021 establishes a protocol for action in these situations. (AU)

Experiencia del Servicio de Medicina Hiperbárica en el tratamiento con oxigenoterapia hiperbárica de pacientes COVID-19 / Lessons identified by the Hyperbaric Departament about the treatment for COVID-19 patients with hyperbaric oxygentherapy

Durante el periodo inicial de la pandemia de COVID-19, y debido a la saturación del sistema asistencial se planteó administrar tratamiento con oxigenoterapia hiperbárica (OHB) a pacientes con PCR + para COVID-19 o con alta sospecha clínica, radiológica y analítica en el Servicio de Medicina Hiperbárica (SMHB) del Hospital Central de la Defensa «Gómez Ulla» (HCD). OBJETIVOS: asistir a pacientes que no respondían a tratamiento, así como comprobar la eficacia de la OHB como una herramienta útil para el tratamiento del COVID-19. MATERIAL Y MÉTODOS: Se valoraron 11 peticiones de tratamiento con OHB, de pacientes procedentes de plantas COVID-19 y UCI, de los cuales finalmente se trataron únicamente a 6 pacientes. Se procedió al tratamiento en cámara multiplaza, entre 1,6 y 2 atmósferas de presión absoluta (ATA) y tiempo de exposición entre 90 y 105 minutos, con la presencia en todo momento de acompañante. Se diseñaron protocolos de protección biológica respiratoria y de contacto frente al coronavirus. Se realizaron controles analíticos y pruebas de imagen. Resultado y conclusiones: Se completaron 35 sesiones de tratamiento. Los pacientes recibieron entre 1 y 14 sesiones No se produjo ningún caso de infección entre los sanitarios del servicio. Los pacientes que por su estado pudieron recibir más de 5 sesiones de OHB tuvieron una mejor evolución clínica. Se observaron reflejos de desaturación postratamiento con OHB

During the first period of the COVID-19 pandemic and due to saturation of the health care system, it was necessary to treat with hyperbaric oxygen therapy (HBO) (in the Hyperbaric Medicine Service at the Defence Central Hospital «Gómez Ulla» (HCD)), some patients with PCR (+) for COVID -19, or with clinical, radiological or analytical high indicative data. OBJECTIVES: to treat patients without positive answer to regular treatment and to check the effectiveness of HBO as useful therapy for COVID-19. MATERIAL AND METHOD: There were valued 11 requests for treatment from COVID-9 wards and the Intensive Care Department. Eventually 6 of those patients were treated. These patients were treated in a multiplace hyperbaric chamber between 1.6 and 2 ATAs and for 90 to 105 minutes of time, with ancillary personnel inside the chamber the whole sessions. There were also developed security protocols to prevent COVID-19 infection. Image and analytics controls were followed. RESULTS AND CONCLUSIONS: 35 sessions of treatment were completed. The patients received from 1 to 14 sessions. It did not happen any case of infection on the medical personnel of the HBO Department. The patients which (due to their physical status) could receive 5 or more sessions had a better clinical evolution. Some desaturation reflexes were observed

Neurological manifestation of arterial gas embolism following standard altitude chamber flight: a case report.

In the course of a decompression at flight level 280 (28,000 ft) in an altitude chamber flight, a 45-yr-old cabin air traffic controller developed sudden numbness in his left upper and lower extremities and, soon after, complete paralysis in the left side, dysarthria and left facial palsy. A presumptive diagnosis of arterial gas embolism (AGE) was made and hyperbaric oxygen therapy (HBO) was given after airevac of the patient to the closest compression facility. Complete resolution of the symptoms was obtained after treatment Table VI-A (extended), plus 3 consecutive HBO treatments (90 min of Oxygen at 2.0 ATA). AGE is a rare event in the course of regular altitude chamber flight and diagnosis should be done in the context of the barometric pressure changes and an acute cerebral vascular injury. Risk factors and follow-up diagnostic procedures are discussed.

[The lung overexpansion syndrome as a diving accident. A review of 22 cases]. / El síndrome de sobreexpansión pulmonar como accidente de buceo. Revisión de 22 casos.

Pulmonary barotrauma (PB) is caused by expansion of gases in the respiratory system. We describe 22 cases in divers that constituted 10.2% of the accidents treated at the Spanish navy's hyperbaric center (1969-1990). Hemoptysis (27.2%), subcutaneous emphysema (22.7%) and chest pain (9.1%) were the most frequent thoracic-pulmonary signs. Changes in consciousness (54.5%) and motility (22.7%) were the main neurological symptoms. The highest indices of PB were recorded during training exercises in diving courses, with 91% of the trauma patients recuperating with no aftereffects thanks to prompt deep (50 m) recompression. Protocols for applying therapeutic tables are described, and the advantages of using tables for oxygen as opposed to air are discussed. Finally, we justify the need to have a hyperbaric chamber nearby for treating this type of accident.

[121 cases of decompression disease]. / Estudio de 121 casos de enfermedad descompresiva.

One hundred and twenty-one subjects with decompression disease (DD) treated by the Spanish Navy between 1969 and 1986 are reported. The mean age of the victims was 31.4 +/- 7.2 years. The leading cause of DD was the partial or complete omission of decompression. The development of type I DD (57%) (basically joint pain) was more common than type II (43%) (neurological vestibular and/or pulmonary features). In 84.3% of cases the clinical features began within 6 hours of the end of immersion, although only 61.5% were treated during the initial 6 hours. When therapy was delayed for longer than 6 hours, the rate of sequelae was considerably increased. The rate of complete recovery after treatment in a compression chamber was 92.7% for type I DD and 71.1% for type II DD.