Diving Medicine

Bové, Alfred A.; Neuman, Thomas S.

doi:10.1016/b978-1-4160-4710-0.00071-7

Cited by 3 publications

(6 citation statements)

References 83 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This supersaturation state is necessary for bubble formation. Once a nidus of bubbles is formed, a host of poorly characterized downstream reactions occur that manifest as DCS symptoms [ 1 ]. In contrast, AGE generally arises from pulmonary over-inflation syndromes, where pressure differentials as little as 0.1 atmospheres absolute (ATA), equivalent to 10.13 kilopascals (kPa), between the intratracheal and intrapleural spaces can exist, leading to barotrauma and alveolar rupture [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Once a nidus of bubbles is formed, a host of poorly characterized downstream reactions occur that manifest as DCS symptoms [ 1 ]. In contrast, AGE generally arises from pulmonary over-inflation syndromes, where pressure differentials as little as 0.1 atmospheres absolute (ATA), equivalent to 10.13 kilopascals (kPa), between the intratracheal and intrapleural spaces can exist, leading to barotrauma and alveolar rupture [ 1 ]. If the inhaled, pressurized gas enters ruptured blood vessels, return to the heart and enter systemic circulation can form an arterial gas embolus, potentially blocking arterial blood flow and leading to ischemia [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, AGE generally arises from pulmonary over-inflation syndromes, where pressure differentials as little as 0.1 atmospheres absolute (ATA), equivalent to 10.13 kilopascals (kPa), between the intratracheal and intrapleural spaces can exist, leading to barotrauma and alveolar rupture [ 1 ]. If the inhaled, pressurized gas enters ruptured blood vessels, return to the heart and enter systemic circulation can form an arterial gas embolus, potentially blocking arterial blood flow and leading to ischemia [ 1 ]. The most severe forms of DCS and AGE present similarly and may present acutely with life-threatening impairments, affecting the nervous, respiratory, or circulatory systems.…”

Section: Introductionmentioning

confidence: 99%

“…Severe DCI impairments impact the nervous and/or cardiopulmonary systems with a wide range of presentations, including headache, vertigo, blindness, nystagmus, numbness, paresthesia, paralysis, dyspnea, seizures, and, at the extreme, cardiovascular collapse and death [ 1 , 2 ]. Among those organ systems afflicted by severe DCI, the central nervous system (CNS) is compromised in the vast majority of cases (>80%), making CNS injury among the most morbid of diving related injuries.…”

Section: Introductionmentioning

confidence: 99%

“…Among those organ systems afflicted by severe DCI, the central nervous system (CNS) is compromised in the vast majority of cases (>80%), making CNS injury among the most morbid of diving related injuries. In examination of the subsets of DCI, neurologic DCS and AGE incidents most often affect the spinal cord (~70%) and brain, respectively [ 1 – 4 ]. The gold standard treatment for DCI is hyperbaric oxygen therapy which is a subset of recompression therapy.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Comparison of treatment recompression tables for neurologic decompression illness in swine model

Johnson

Roney²,

Zhou³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Background Significant reductions in ambient pressure subject an individual to risk of decompression illness (DCI); with incidence up to 35 per 10,000 dives. In severe cases, the central nervous system is often compromised (>80%), making DCI among the most morbid of diving related injuries. While hyperbaric specialists suggest initiating recompression therapy with either a Treatment Table 6 (TT6) or 6A (TT6A), the optimal initial recompression treatment for severe DCI is unknown. Methods Swine were exposed to an insult dive breathing air at 7.06 ATA (715.35 kPa) for 24 min followed by rapid decompression at a rate of 1.82 ATA/min (184.41 kPa/min). Swine that developed neurologic DCI within 1 hour of surfacing were block randomized to one of four United States Navy Treatment Tables (USN TT): TT6, TT6A-air (21% oxygen, 79% nitrogen), TT6A-nitrox (50% oxygen, 50% nitrogen), and TT6A-heliox (50% oxygen, 50% helium). The primary outcome was the mean number of spinal cord lesions, which was analyzed following cord harvest 24 hours after successful recompression treatment. Secondary outcomes included spinal cord lesion incidence and gross neurologic outcomes based on a pre- and post- modified Tarlov assessment. We compared outcomes among these four groups and between the two treatment profiles (i.e. TT6 and TT6A). Results One-hundred and forty-one swine underwent the insult dive, with 61 swine meeting inclusion criteria (43%). We found no differences in baseline characteristics among the groups. We found no significant differences in functional neurologic outcomes (p = 0.77 and 0.33), spinal cord lesion incidence (p = 0.09 and 0.07), or spinal cord lesion area (p = 0.51 and 0.17) among the four treatment groups or between the two treatment profiles, respectively. While the trends were not statistically significant, animals treated with TT6 had the lowest rates of functional deficits and the fewest spinal cord lesions. Moreover, across all animals, functional neurologic deficit had strong correlation with lesion area pathology (Logistic Regression, p < 0.01, Somers’ D = 0.74). Conclusions TT6 performed as well as the other treatment tables and is the least resource intensive. TT6 is the most appropriate initial treatment for neurologic DCI in swine, among the tables that we compared.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of treatment recompression tables for neurologic decompression illness in swine model

Johnson

Roney²,

Zhou³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

Diving Medicine

Bové

2014

Am J Respir Crit Care Med

View full text Add to dashboard Cite

Exposure to the undersea environment has unique effects on normal physiology and can result in unique disorders that require an understanding of the effects of pressure and inert gas supersaturation on organ function and knowledge of the appropriate therapies, which can include recompression in a hyperbaric chamber. The effects of Boyle's law result in changes in volume of gas-containing spaces when exposed to the increased pressure underwater. These effects can cause middle ear and sinus injury and lung barotrauma due to lung overexpansion during ascent from depth. Disorders related to diving have unique presentations, and an understanding of the high-pressure environment is needed to properly diagnose and manage these disorders. Breathing compressed air underwater results in increased dissolved inert gas in tissues and organs. On ascent after a diving exposure, the dissolved gas can achieve a supersaturated state and can form gas bubbles in blood and tissues, with resulting tissue and organ damage. Decompression sickness can involve the musculoskeletal system, skin, inner ear, brain, and spinal cord, with characteristic signs and symptoms. Usual therapy is recompression in a hyperbaric chamber following well-established protocols. Many recreational diving candidates seek medical clearance for diving, and healthcare providers must be knowledgeable of the environmental exposure and its effects on physiologic function to properly assess individuals for fitness to dive. This review provides a basis for understanding the diving environment and its accompanying disorders and provides a basis for assessment of fitness for diving.

show abstract

Dilemma of Natural Death While Scuba Diving

Sadler

Nelson

Grover

et al. 2013

Academic Forensic Pathology

View full text Add to dashboard Cite

Sudden death from natural causes occurs frequently and the cause is often not discovered until the time of autopsy. Just as it occurs on land, so too do natural deaths occur in the water. However, the deaths may be inappropriately attributed to drowning simply due to their occurrence in the water, particularly in the case of scuba divers. We emphasize the importance of taking into consideration all factors when investigating these deaths, with particular emphasis on witness statements, equipment analysis, and autopsy findings in attempt to avoid the mischaracterization of sudden natural death in the water as drowning. We present two cases of sudden death in middle-aged males while scuba diving. Upon close examination of the autopsy findings, in conjunction with the eyewitness statements regarding the circumstances of their deaths, the cause of death was ultimately determined to be due to their significant cardiac disease, rather than drowning. In cases such as these, particular importance must be given to heart weight, evidence of coronary artery disease, lung weights, and evidence of aspiration on autopsy. If the evidence suggests death due to cardiac disease, these deaths should be categorized as natural deaths and not drownings.

show abstract

Diving Medicine

Cited by 3 publications

References 83 publications

Comparison of treatment recompression tables for neurologic decompression illness in swine model

Comparison of treatment recompression tables for neurologic decompression illness in swine model

Diving Medicine

Dilemma of Natural Death While Scuba Diving

Contact Info

Product

Resources

About