Archive for the ‘SCUBA Diving Injuries’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site: www.wildernessmedicinenewsletter.com

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

Wilderness Medicine by Paul S. Auerbach, MD, MS

April 9, 2007

Once again, Paul Auerbach has managed to provide us with a tome that holds an absolute wealth of information. He has not only updated all the information contained in the previous edition, but he has also called upon more experts in the field who have added a wide variety of new topics. The list of contributing authors reads like a Who’s Who in Wilderness Medicine and Rescue. This text is a true accomplishment and a marvelous contribution to the wild side of medicine.

The Fifth Edition, 2007, consisting of 2316 pages is divided into 97 chapters, written by 157 contributing authors. A myriad of charts, tables, and spectacular photography complement the well-written text.

Needless to say, I have not had the time to read the entire book, but the several chapters I have read were packed with valuable information for all of us who are interested in or participate in wilderness medicine and rescue work.

Paul, a personal thanks. Great job! What a tremendous contribution this text will make to emergency medicine that is practiced in the extended care environment.

Wilderness Medicine, Fifth Edition, by Paul S. Auerbach, MD, MS is published by Mosby, ISBN 978-0-323-03228-5 and available through www.elsevier.com and probably amazon.com.

BAROTRAUMA & DYSBARISMS #9

January 31, 2007

DECOMPRESSION SICKNESS (DCS):

Rapid reduction in ambient pressure, during ascent, causes dissolved gases to come out of
solution and form bubbles of nitrogen, the oxygen is rapidly metabolized in the tissues.

Gas bubbles can: 
– obstruct small blood vessels
– cause changes in blood chemistry
– stretch and damage tissues

Symptoms present within 12 hours.
– 80% within 1 hour of surfacing.
– 95% within 4 hours of surfacing.

TYPE I  – musculoskeletal limb pain
BENDS = periarticular pain in arms & legs (arms > legs)
pain relieved by direct pressure
pain can be mild, “Niggles,” to severe
skin/lymphatic involvement = pruritus, marbling, rashes

TYPE II – neurological
pain in areas other than the extremities
CNS changes = cord involvement or cerebral
spinal cord DCS = most common form of DCS in divers
paresthesia s – ascending numbness – paraplegia
urinary retention – fecal incontinence – priapism

Cerebral DCS:
classic CVA symptoms
pulmonary manifestations – “CHOKES”
occurs within minutes of surfacing
substernal chest pain – cough – dyspnea
can progress to respiratory failure and shock
labyrinthine or inner ear DCS – “STAGGERS”
vertigo – nausea/vomiting – tinnitus – hearing loss – nystagmus
                 
TREATMENT FOR DCS TYPE I & II:    
RECOMPRESSION
100% oxygen (helps to wash out nitrogen)
IV fluid therapy with crystalloid (hemoconcentration)
diazepam or phenergan for vertigo – nausea – vomiting
should not dive for 6 months after DCS & not until full evaluation

RECOMPRESSION – HYPERBARIC THERAPY
to reduce the size of the bubbles
to promote reabsorption
prevent further bubble production

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #8

January 29, 2007

ARTERAIL GAS EMBOLISM:  (AGE)Most serious of all dive injuries – frequently fatal.
Second only to drowning in fatalities in sport divers.
Ruptured airways allow air bubbles to enter the pulmonary circulation and go to the left side of the heart.
From the left ventricle may migrate to the coronary or cerebral circulation.
Resulting in:
ACUTE MYOCARDIAL INFARCTION (AMI)
CEREBROVASCULAR ACCIDENT (CVA)
AGE usually presents within 10 minutes of the “burst lung”.

SYMPTOMS: 
CVA = neurological symptoms:
change in mood or affect
visual disturbances
hemiplegia or hemiparesis
unconsciousness

AMI = apnea – dyspnea
chest pain – chest pressure
dysrhythmia s – asystole

SUDDEN LOSS OF CONSCIOUSNESS BEFORE SURFACING IS AGE UNTIL PROVEN OTHERWISE

TREATMENT:  RECOMPRESSION!!!
100% O2 while transporting
Transport supine & MONITOR AIRWAY

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #7

January 27, 2007

PNEUMOMEDIASTINUM & INTERSTITIAL EMPHYSEMA:
Ruptured airways allow air to escape into the soft tissues.
Air dissects into the mediastinal – into the pericardium – cephalad into the neck.

SYMPTOMS: 
subcutaneous air & crepitus on compression of the skin – neck
change in voice
dyspnea
pericardial air on x-ray

TREATMENT: 
Interstitial (subcutaneous) emphysema is not dangerous.
100% O2 will hasten recovery.
Must be monitored for other sequela = pericardial tamponade.

PNEUMOTHORX:   (TENSION PNEUMOTHORAX)
Ruptured airways allow air to escape into the pleural space.
Air trapped in the pleural space.

SYMPTOMS: 
Vary from mild to severe dyspnea with cyanosis.

TREATMENT: 
Monitor if mild.
100% O2 in severe cases, may require artificial ventilation.
Chest tube thoracotomy for severe = tension pneumothorax.
Needle thoracotomy in emergency.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #6

January 25, 2007

ASCENT INJURIES:  “REVERSE SQUEEZE”

ASCENT   = expansion of the gas.     
The volume of gas increases by 2, doubles, every 33 fsw.

This is why it is an absolute rule that people with asthma cannot SCUBA dive!
ASTHMA and SCUBA diving = death
.
During ascent some of the air breathed at depth will get trapped in the alveoli and bronchioles, then during ascent that trapped air will expand and burst the alveoli and bronchioles, resulting in burst lungs and DEATH.

PULMONARY OVERINFLATION:
“Pulmonary Over Pressurization Syndrome” – POPS = “Burst Lung”
Usually occurs with a rapid ascent and breath holding.
Gas in the lung expands rapidly causing alveolar rupture.  (Boyle’s Law)
Alveolar rupture allows air to be forced into other tissues/spaces.
Resulting in escape of air under pressure into the:
Mediastinum = PNEUMOMEDIASTINUM/INTERSTITIAL EMPHYSEMA
Pleural Space = PNEUMOTHORAX
Pulmonary Venous System = ARTERIAL GAS EMBOLISM  (AGE)

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

 

BAROTRAUMA & DYSBARISMS #5

January 22, 2007

ALTERNOBARIC VERTIGO: 

This occurs when there is unilateral pressure difference between middle & inner ear.
More common during ascent then descent.

SYMPTOMS: 

sudden transient vertigo – usually less than one minute.
overwhelming feeling of disorientation.
vertigo may persist on the surface.
accompanied with nausea, vomiting, nystagmus.
no tinnitus

TREATMENT: 

usually not required = transient.
decongestants may speed recovery, 
(occasionally a myringotomy is required.)

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #4

January 20, 2007

EXTERNAL EAR SQUEEZE:   “Barotitis externa”

The External Auditory Canal (EAC) is occluded by cerumen, ear plugs, or wet suit hood. 
As the external pressure increases during descent the “plug” prevents the outside pressure from equalizing in the EAC. 
The EAC becomes edematous and hemorrhagic.
Pain is not relieved by Valsalva or Frenzel maneuver.

PREVENTION:   STOP THE DESCENT and ASCEND to where it is pain free.

TREATMENT:    
Cortisporin Otic Solution or other steroid ear drop.

INNER EAR BAROTRAUMA:  “Barotitis interna”

A pressure differential develops between the middle and inner ears that causes an implosion or explosion of the round or oval windows that separate the inner and middle ear.

SYMPTOMS: 
sudden onset
severe vertigo
roaring tinnitus
nystagmus
fullness of the affected ear
sensorineural hearing loss
does not improve with ascent

TREATMENT:  Antivertigo drugs:
meclizine (Antivert)
diazepam (Valium)
Follow-up with ENT before diving again

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #3

January 18, 2007

BAROTRAUMA:  (Boyle’s Law) DESCENT = compression of the gas.  (volume decreases by 1/2 every 33 fsw)
ASCENT   = expansion of the gas.      (volume increases by 2 every 33 fsw)
(fsw = feet of sea water)

Boyle’s Law – This is why it is an absolute rule that people with asthma cannot SCUBA dive!ASTHMA and SCUBA diving = death.
During the dive some of the air breathed in at depth gets trapped in the alveoli and bronchioles.
Then during ascent that trapped air will expand and burst the alveoli and bronchioles, resulting in burst lungs and DEATH.
         
DESCENT INJURIES:  “SQUEEZE INJURIES”
DESCENT = compression of the gas.  (volume decreases by 1/2 every 33 fsw)

MIDDLE EAR SQUEEZE:  “Barotitis media”
The Eustachian Tube that connects the middle ear to the sinuses is not venting properly.
This prevents the air pressure from the SCUBA tank from getting into the middle ear. 
As a result, there is more pressure outside then in, increasing the pressure against tympanic membrane.
This causes the tympanic membrane (TM) to be pushed inward, causing pain and bleeding of the TM.
Increased pressure in middle ear causes mucosal bleeding and edema of the TM and the middle ear tissues.
If the diver ignores the pain and continues to descend the pressure will increase and the tympanic membrane may rupture inward. 
Water then rushes into the middle ear causing severe vertigo as a result of caloric vestibular stimulation.
 
PREVENTION: 
Valsalva or Frenzel maneuver, to equalize the pressures between the sinuses and the middle ear.   
Long-acting Decongestants/Antihistamines used for 3 days prior to dive.
Inhaled Nasal Steroids used for 7 days prior to dive.

TREATMENT:  
STOP THE DESCENT and ASCEND to where it is pain free.
Decongestant/Antihistamine.
Monitor for onset of Otitis Media.

CONTRAINDICATIONS FOR A DIVE:
Perforated Tympanic Membrane
Sinusitis
Upper Respiratory Tract Infection
Asthma is an absolute contraindication to diving, ever.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

BAROTRAUMA & DYSBARISMS #2

January 16, 2007

BREATHING A GAS UNDER PRESSURE: (Henry’s Law)

NITROGEN NARCOSIS:  “rapture of the deep”
Breathing nitrogen under pressure has an anesthetic-like effect.
In SCUBA diving there is the “Martini Rule” = every 50′ of depth is like having one martini.
Symptoms are similar to being inebriated:
At 100′ you may feel lightheaded, euphoric, have poor reaction timing, and POOR JUDGEMENT.
At 300′ you may become unconscious.
You most likely will not realize that you have “rapture of the deep” just like you don’t know how drunk you are.  You have to rely upon one another to keep an eye on each other.

CARBON MONOXIDE:  

A little goes a long way. 
Have to make sure that your SCUBA tanks are properly filled and there is no risk of CO contamination. 
A very small quantity of CO in the pressurized air you breathe will lead to loss of conscious while diving.
Symptoms of CO poisoning are unconsciousness, drowning, and DEATH.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.


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