Treatment of cardiac arrest in the hyperbaric environment: key steps on the sequence of care--case reports.

The U.S. territory of Guam attracts thousands of military and civilian divers annually and is home to the only recompression facility within a 5,000-km radius that accepts critically injured dive casualties. As recompression chambers are confined spaces and standard use of electrical cardioversion cannot be used, cardiac resuscitation at depth must deviate from advanced cardiovascular life support (ACLS) algorithms. Furthermore, many hyperbaric chambers that accept dive casualties are in remote locations, a situation that requires providers to approach cardiac resuscitation in a different way when compared to an in-hospital or ICU setting. This presents a challenge to trained medical and diving professionals. We present two contrasting vignettes of diving injuries initially responsive to appropriate treatment but then deteriorating during recompression therapy and ultimately requiring resuscitation at depth. Additionally, we explore the physiologic basis of resuscitation in a hyperbaric environment as it relates to the treatment of cardiac arrest at depth. This review critically examines the current guidelines in place for emergency cardiac resuscitation in a hyperbaric chamber followed by recommendations for the key steps in the sequence of care.

Obturator-orbital prosthesis.

A technique is described to treat patients who have had mutilating surgery, resulting in facial disfigurement, loss of an eye, and a surgical defect in the palate. The technique utilizes an occular prosthesis, a hollow-bulb obturator, and complete dentures.

An evaluation of cross-bite ridge relationships. A study of articulated jaw records of 150 edentulous patients.

Data were collected from 150 men and women complete-denture patients. Their jaw records were evaluated with a specially designed instruments. The extent of deviation of the maxillary and the mandibular ridges in the horizontal plane was calculated at various interridge distances, at a constant interalveolar crest-line angle of 80 degrees. It was found that: 1. Most patients of both sexes revealed a normal horizontal ridge relationship. 2. Next to the normal ridge relationship, there was a tendency for a unilateral cross-bite ridge relationship on the left sides of those patients who had recent extractions (up to 6 months previously). 3. True bilateral cross-bite ridge relationships were found only in those patients who gave a history of prolonged edentulousness. 4. The decision to arrange the posterior teeth in normal or cross-bite ridge relationship should take into consideration the deviations in the ridge relationship as well as the interridge distance. A method of evaluating interridge deviations in the horizontal plane in the posterior region of articulated jaw records of edentulous patients was developed.