scubadoc Ten Foot Stop

November 30, 2005

UHMS News from Don Chandler - Four Important Matters

Filed under: Uncategorizedscubadoc @ 1:41 pm

To all-

So those of you who are interested in the following issues can do some advance planning the following announcements are important:

1. UHMS/NOAA Physician Course date change. Due to a heavy workload during the fall at the NOAA Diver Training Center, the date for the next UHMS/NOAA Physician’s Course had to be changed to 10-21 July 2006. This will require those of you who want to attend the course to get your applications in much earlier than in previous years. Because of this three month change, the only way we at the UHMS home office can support it for 2006 is to accept the applications on a first-come, first-serve basis. That is to say we will accept the first 30 applications we receive rather than waiting to receive all the applications and sending them off to Dr. Morgan Wells for his review and selection. We are not sure at this time about course dates for years beyond 2006 but will let you know as we learn about future schedules.

2. Next Fitness to Dive Course is in Charleston, SC 16-19 March 2006. The next very popular Fitness to Dive Course will be held in beautiful and historic Charleston, South Carolina on the dates listed herein. Lisa is currently arranging for a venue and we will let you know all the details as soon as we have a contract. You can apply be going to our website www.uhms.org scrolling down to the box about the course, click where indicated and it will take you to where you can get an application…either for on-line registration or by fax or by regular mail. March is a great time of year to visit Charleston, SC, what with the great spring weather there and with the azaleas in bloom. Please sign on for this course soon.

3. Plan to attend our annual scientific meeting in Orlando. As I write this, our Scientific Meeting Planning Committee is meeting with Lisa and the convention managers of the Hilton Hotel at Disney World in Orlando, Florida to look at our meeting spaces and to make final arrangements for our annual meeting there in June. We are planning a joint effort with Divers Alert Network and SUNY Buffalo for a two-day pre-course on Breath Hold Diving that will be held on 20-21 June. We will also be offering a hyperbaric medicine pre-course entitled “How to Get Paid and Stay Out of Jail” which will be held on 21 June. Our Associates will be planning a pre-course so far as we know at the moment (will let you know more about this later). Following our annual scientific meeting June 22-24, we will be offering a post-course “Medico-Legal Aspects of Fitness to Dive” (morning session) and “Medico-Legal Aspects of Practicing Hyperbaric Medicine” (afternoon session) which is scheduled for Sunday, 25 June. We will also be partnering with ATMO for a 25 June post-course entitled “Inspection, Maintenance, and Documentation of Chamber Acrylics.” We will also be conducting our annual “How to Prepare for Facility Accreditation” that Tom Workman teaches (more details later on this). As you can see, we will have lots to offer this June. Plan to be there…you will not be disappointed.

4. The UHMS 40th Anniversary Meeting in Maui, Hawaii, 14-16 June 2007. The Ritz-Carlton Hotel and Resort at Kapalua, rated as one of the two best in the world, is the location for our 2007 annual scientific meeting. We will celebrate the 40th anniversary of our Society with several special events, none of which you will want to miss. And the cost to our members? Better than we could have possibly imagined when we started looking for a place to have our 40th anniversary meeting. Lisa has negotiated garden/golf/mountain view rooms at this 5-star resort for $215 per night, partial ocean view at $240 and ocean view at $265. She has also arranged for 20 rooms at the 2007 government per diem rate ($160 this year) for military, government employees and our Associates. Usual rates for these rooms range from $265 to $415 per day. The room rates as negotiated will be honored by the Ritz Carlton three days prior and three days after the peak nights of 13-15 June. Lisa has negotiated a bargain for you here and you can take advantage of it…our estimated savings from just the complimentary suites and no resort fees currently stands at $41,300 and will be more when the cost for the per diem rooms is set. Plans are still in the works for pre- and post-courses but we will be offering a pre-course entitled “Are Asthmatics Fit to Dive?” and will be updating our own publication of the same title from the proceedings. We are looking for someone to take the lead in arranging another ever popular Dive Expedition as we did in San Diego and Australia…if you are interested, please let me know.

Don

2005 International Consensus on CPR, from Omar Sanchez, MD

Filed under: Uncategorizedscubadoc @ 11:42 am

Dr. Omar Sanchez, a cardiologist diver in Buenos Aires posts this very valuable information concerning recent updates in CPR guidelines.

Available at: http://circ.ahajournals.org/content/vol112/22_suppl/
http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5
And: http://circ.ahajournals.org/rapidaccess.shtml

From Buenos Aires, Omar Sanchez, Wetdoc.

Scholarship Deadlines Extended by Women Divers Hall of Fame

Filed under: Uncategorizedscubadoc @ 10:09 am

The Women Divers Hall of Fame (WDHOF), the international non-profit organization that is dedicated to the women who shape the world of diving, has announced that they have extended the deadline for their 2006 scholarship applications to January 31, 2006. WDHOF provides educational and financial support for individuals of all ages who wish to pursue higher education & training, further career goals, and seek out opportunities in the aquatic and diving-related industries.

The scholarships involved are:

Cecelia Connelly Memorial Scholarship - awarded to a woman diver who is enrolled in an accredited course of study in the field of Underwater Archeology.

Hugh Fletcher Memorial Scholarship - awarded to a disabled individual who wishes to begin or further their dive education. Candidates can be male or female.

Ocean Pals Scholarship - awarded to a female (age 13-18) to be used towards an entry level or advanced diving related educational program.

Reimers Systems Scholarships (2) – awarded to a diver to be used towards a Certified Hyperbaric Technician course. Candidates can be male or female.

Scuba Made Easy Scholarship - awarded to a woman diver working in the areas of marine sciences, oceanography or ocean engineering.

Undergraduate Marine Research Internship Scholarship - awarded to a female student who is participating in a marine biology internship.

Hillary Viders, Ph.D. Scholarship - awarded to a woman who is enrolled in an accredited course of study in the field of marine science and conservation.

Women Divers Hall Of Fame Scholarship - awarded to a woman of any age who wishes to begin or further her dive education.

Women’s Scuba Association Scholarship - awarded to a participant in the Navy’s NJROTC or NROTC program. Candidates can be male or female.

Women Underwater Scholarship - awarded to a woman diver to continue her education/training in the area of technical diving.

To learn more about the WDHOF organization visit: www.wdhof.org For additional scholarship information, criteria and applications visit: www.wdhof.org/scholarship.html

DAN Board of Directors Name Dan Orr to Post of DAN President and CEO

Filed under: Uncategorizedscubadoc @ 9:56 am

Divers Alert Network has named Dan Orr as President and CEO of the dive
safety organization. The appointment follows the announcement at DAN of the
resignation of Dr. Michael D. Curley.

William Anlyan, chairman of the DAN Board of Directors, made the
announcement to the DAN staff on Wednesday, Nov. 23.

Anlyan praised Orr for his long and distinguished career at DAN and in the
dive industry. ‘DAN is fortunate to have a man of his experience and service
to lead this organization forward,’ he said. ‘The Board is excited to have
Dan Orr at the helm.’

Orr said it is both an honor and privilege to be asked to lead DAN. ‘I
pledge to continue DAN¹s vital mission of providing the very best emergency
medical and educational services available to the diving public, as well as
finding new and innovative ways of serving our members and stakeholders,’ he
said.

‘This fulfills a dream of merging my love of diving with my desire to
continue to improve diving safety. I hope to live up to the high standards
set by the exceptionally qualified and dedicated professionals who work here
at DAN.’

Orr, a veteran diver of 40-plus years, has served DAN in various positions,
most recently, Executive Vice President and Chief Operating Officer, Vice
President for Training and Training Director. He joined DAN in 1991 and
immediately established the DAN Training department and the Oxygen for Scuba
Diving course, a standard in the dive industry.

Orr has held membership and leadership positions in many notable diving
organizations such as NAUI, PADI, ACUC, YMCA, NASE, IAND, UHMS, NACD, the
Historical Diving Society, Academy of Underwater Arts and Sciences,
Institute of Diving and the Explorers Club. He is Chairman of the Board of
the Historical Diving Society and Secretary of the DEMA Board of Directors.

At Wright State University, in Dayton, Ohio, Orr created comprehensive diver
education program offered for academic credit from 1973-1988. This program
consisted of all levels of certification from entry-level through
instructor-trainer.

At Florida State University from 1988-1991, as Instructional Coordinator and
Associate Diving Safety Officer, he revamped the existing diver education
program, offering academic credit through the marine sciences department.
This program expanded emphasis on diver safety and skill development. He was
Diving Safety Officer for the first Mixed Gas Workshop conducted by Florida
State University and conducted at the FSU Marine Lab and Wakulla Springs
State Park.

In a statement to the DAN staff, Anlyan expressed appreciation to Curley for
his service to DAN and acknowledged the fine accomplishments during Curley¹s
21-month tenure. Curley¹s resignation was effective Nov. 22, 2005.

‘Both the Board and Dr. Curley agree that as this holiday season approaches,
the time is opportune for the transition, in anticipation of the challenges
the new year will bring,’ he said. ‘Dr. Curley plans to resume his
independent consultancy career with his firm in Connecticut.’

Dr. Curley¹s statement to the staff read, ‘I am most grateful for having the
opportunity to lead this fine organization and to meet many of our DAN
family. It has been my great privilege to support the terrific assistance
provided by DAN¹s staff to divers in need.’

For more information, contact DAN Communications at +1-919-684-2948.

November 28, 2005

New Corporate Member Designation, UHMS

Filed under: Uncategorizedscubadoc @ 2:17 pm

The UHMS Board of Directors met in Durham, NC on Friday, October 28, 2005. One of the Board’s actions was to create a separate Accredited Corporate Member category for accredited facilities. Prior to this action, accredited facilities received a complimentary one-year general corporate membership as a benefit of accreditation. Accredited facilities will now receive the following benefits:

—Accredited Corporate Membership for the duration of their accreditation period (three-years)
—A plaque suitable for display in a prominent location of the healthcare facility
—A quarterly report from the Board of Directors highlighting Society activities related to regulatory issues, reimbursement, Fiscal Intermediary communication, etc.
Note: Communication will be directed to the healthcare facility senior management, not the Medical Director of the hyperbaric facility to keep the leadership of the organization current with issues related to the practice of hyperbaric medicine
—An electronic copy of Pressure
—Expanded facility information on the UHMS website to include contact information, category of accreditation (Level One, Two, Three), etc., thus making the listing more beneficial to patients and referring physicians
—Authorization to use the UHMS logo on stationery, marketing brochures, etc., indicating that the facility is accredited by the UHMS
To accommodate these new benefits, the accreditation survey fee will be $4500 for all applications for survey received after January 1, 2006. Other accreditation fees remain unchanged.

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Hyperbaric Chambers on scubadoc Diving Medicine Online

(Free)

Question about Meniere’s surgery and Diving

Filed under: Uncategorizedscubadoc @ 11:19 am

I have Meniere’s Desease. I am having surgery for it that will hopefully work. The surgery involves going through the skull behind the ear, putting a shunt in the inner ear sac and also injecting a fluid toxic to the balance nerve.

I also have a PE tube in my eardrum to help with my abnormally small eustachion tube and trouble equalizing (under water, in airplanes, etc.).

Can I dive after the surgery and/or with the tube in my ear?
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Answer:
All divers require functioning eustachian tubes because of the need for equalizing pressure in the middle ears as they descend and ascend in the water. Inability to ‘clear’ or equalize allows a high risk of damage to your good ear, with the risk of deafness or other nerve damage from barotrauma.

The tube in your ear would also allow water (and bacteria) to enter the middle ear, causing you to be at major risk for infection and caloric vertigo underwater - a major risk for drowning.

Even if your surgery is totally successful, you would be at risk for vertigo underwater from the imbalance of your killed nerve (alternobaric vertigo), again a major risk for drowning.

A last consideration would be the risk of occurrence of inner ear decompression sickness or barotrauma. It would extremely difficult to differentiate symptoms of these injuries from the effects of your surgery. These two conditions might possibly severely disrupt or damage your surgical results.

I m not aware of any studies on problems such as yours but would hesitate to certify you as ‘fit to dive’, considering all of the caveats listed above - any one of which would be cause to disallow diving. More information on our web site at http://www.scuba-doc.com/entprobs.html .

I am sending your query to one of our ENT scuba diving consultants for another opinion.

I hope this is helpful!

Ern Campbell, MD
scubadoc Diving Medicine
http://scuba-doc.com
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Answer from ENT Consultant, Dr. Allen Dekelboum:

Your request was referred to me for comment. I am very familiar with the procedure you are having, but have more concerns about your difficulty in equalizing while flying and in the water. How long have you been diving with the PE tube in place and how do you protect your middle ear from water getting into it through the tube? If you have a tube in place, I would not recommend any scuba diving. Also, an episode of Meniere’s with vertigo while you are underwater can be very hazardous to your life.

Allen Dekelboum, M.D.

References to Meniere’s disease and Diving in scubadoc Diving Medicine Online

Blast Injuries: A Review in Medscape

Filed under: Uncategorizedscubadoc @ 11:15 am

Introduction
Terrorism
Explosions and Explosive Devices
Mechanisms of Injury and Injury Patterns in Explosions
General Management
Pulmonary Injuries
Gastrointestinal (GI) Injuries
Neurologic Injuries
Auditory Injuries
Orthopedic Injuries
Ocular Injuries
Miscellaneous Injuries
Summary
Additional Resources
References

http://www.medscape.com/viewprogram/4714?src=mp


References to Underwater Blast Injuries in scubadoc Diving Medicine Online

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Malaria Vaccine Effective in Clinical Trial

Filed under: Uncategorizedscubadoc @ 11:09 am

http://snipurl.com/jy0h

Malaria References in scubadoc Diving Medicine Online

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U.S.S. Safeguard concludes SALVEX exercises

Filed under: Uncategorizedscubadoc @ 11:05 am

http://snipurl.com/i1lh
http://www.military.com/NewsContent/0,13319,77862,00.html

Nitrogen Narcosis reference in scubadoc Diving Medicine Online

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The Hyperbaric Healing Institute has Risks of HBOT on it’s web page

Filed under: Uncategorizedscubadoc @ 10:56 am

Hyperbaric Healing Institute
http://www.hhi-kc.com/sideeffects.htm

Side Effects
As with any treatment, side effects are possible. However, with hyperbaric oxygen therapy they are minimal. The most common is barotrauma to the ears and sinuses caused by pressure changes.

Patients are taught autoinflationary techniques to promote adequate clearing of the ears during treatment. Decongestants may be helpful. This problem is temporary and resolves when HBO treatment is completed.

If the patient has ear pain or is unable to clear his or her ears, the insertion of myringotomy tubes may be necessary before the treatment continues.

Taken from a 10-year study of 1,505 patients who received 52,758 2-hour HBO treatments at 2.4 ata once or twice daily (The maximum treatment protocol used for problem wounds around the world).

Inability to equalize middle ear pressure 0.37%
Paranasal sinus blocks 0.09%
Confinement anxiety 0.05%
Oxygen convulsions 0.009% (all ceased after removing hood/masks)
Pulmonary oxygen toxicity 0.00%
Permanent ocular refractive changes 0.00%

Other side effects are more rare.

Oxygen toxicity can cause CNS and pulmonary effects. Seizures occur rarely during treatment and are self limiting.
Seizures will cease when the patient is removed from breathing the pure oxygen.
Factors such as history of seizures, high temperature, acidosis and low blood sugar are taken into account before treatment is begun.
Pulmonary oxygen toxicity may occur in patients who require supplemental oxygen between treatments. This is very rarely seen with the limited number of treatments currently used.
Some patients may suffer claustrophobia. This is managed by maintaining communication, use of relaxation techniques and mild sedation, if necessary. Incidents of claustrophobia, however, are decreased by HHI’s large diameter multiplace chamber.
Rarely, patients develop temporary changes in eyesight; these are minor and occur only in those individuals who have large numbers of treatments. Vision usually returns to normal within eight weeks following the end of treatments.
Patients with cataracts may experience accelerated maturation of the cataract, but the treatments do not cause cataract formation.

Contraindications
Anyone with any of the following conditions may not be a suitable candidate for HBOT:

1. Asthma - Small airway hyper-reactivity may result in air trapping and pulmonary barotrauma on ascent. A decision to treat such patients should not be undertaken lightly, particularly in light of evidence that the administration of some bronchodilators may increase the incidence of cerebral arterial gas embolism through pulmonary vasodilation.

2. Congenital spherocytosis - Such patients have fragile red cells and treatment may result in massive haemolysis

3. Cisplatinum - There is some evidence that this drug retards wound healing when combined with HBO.

4. Disulphiram (Antabuse) - There is evidence to suggest that this drug blocks the production of suproxide dismutase and this may severely effect the body’s defenses against oxygen free radicals. Experimental evidence suggest that a single exposure to HBO is safe but that subsequent treatments may be unwise.

5. Doxorubicin - (Adriamycin). This chemotherapeutic agent becomes increasingly toxic under pressure and animal studies suggest at least a one week break between last dose and first treatment in the chamber.

6. Emphysema with CO2 retention - Caution should be exercised in giving high pressures + concentrations of oxygen to patients who may be existing on the hypoxic drive to ventilation. Such patients may become apnoeic in the chamber and require IPPV. In addition, gas trapping and subsequent lung rupture are associated with bullous disease.

7. High Fevers - High fevers (>38.5degC) tend to lower the seizure threshold due to O2 toxicity and may result in delaying of relatively routine therapy. If patients are to be treated then attempt should be made to lower their core temperature with antipyretics and physical measures

8. History of middle ear surgery or disorders - These patients may be unable to clear their ears, or risk further injury with vigorous attempts to do so. An ENT consult for possible placement of grommets is usually wise

9. History of seizures - HBO therapy may lower the seizure threshold and some workers advocate increasing the baseline medication for such patients

10. Optic Neuritis - There have been reports in patients with a history of optic neuritis of failing sight and even blindness after HBO therapy. This complaint would seem to be extremely rare but of tragic consequence.

11. Pneumothorax - A pocket of trapped gas in the pleura will decrease in volume on compression and re-expand on surfacing during a cycle of HBO therapy. During oxygen breathing at depth nitrogen will be absorbed from the space and replaced with oxygen. These fluxes of gases and absolute changes in volume may result in further lung damage and or arterial gas embolization. If there is a communication between lung and pneumothorax with a tension component, then a potentially dangerous situation exists as the patient is brought to the surface. As Boyle’s Law predicts, a 1.8 litre pneumothorax at 20 msw is potentially a 6 litre pneumothorax at sea level - certainly a life threatening situation. For this reason it is mandatory to place a chest tube to relieve a pneumothorax before contemplating HBO therapy. Particular care must be taken with patients who give a history of chest trauma or thoracic surgery.

12. Pregnancy - The fears that either retrolental fibroplasia or closure of the ductuc arteriosus may result in the fetus whose mother undergoes HBO appear to be groundless from considerable Russian experience. However, HHI continues to exercise caution in limiting treatment of pregnant women to emergency situations.

13. Upper Respiratory Tract Infections - These are relative contra-indications due to the difficulty such patients may have in clearing their ears and sinuses. Elective treatment may be best postponed for a few days in such cases.

14. Viral Infections - Many workers in the past have expressed concern that viral infections may be considerably worsened after HBO. There have been no studies to give convincing evidence of this and no reported activation of herpetic lesions associated with HBO.

References to Risks of HBOT on scubadoc Diving Medicine Online

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