scubadoc Ten Foot Stop

September 28, 2008

Arterial gas embolism: a review of cases

Filed under: Article, Publicationscubadoc @ 11:13 am

There is an article in Anaesth Intensive Care. 2008 Jan;36(1):60-4, “Arterial gas embolism: a review of cases at Prince of Wales Hospital, Sydney, 1996 to 2006″ by Trytko BE, Bennett MH that is well written and reports on the experience of a hyperbaric facility that utilizes evidence based guidelines for HBO treatment. 

 
Arterial gas embolism may occur as a complication of diving or certain medical procedures. Although relatively rare, the consequences may be disastrous. Recent articles in the critical care literature suggest the non-hyperbaric medical community may not be aware of the role for hyperbaric oxygen therapy in non-diving related gas embolism. This review is part of an Australian appraisal of experience in the management of arterial gas embolism over the last 10 years. We identified all patients referred to Prince of Wales Hospital Department of Diving and Hyperbaric Medicine with a diagnosis of arterial gas embolism from 1996 to 2006. Twenty-six patient records met our selection criteria, eight iatrogenic and 18 diving related. All patients were treated initially with a 280 kPa compression schedule. At discharge six patients were left with residual symptoms. Four were left with minor symptoms that did not significantly impact quality of life. Two remained severely affected with major neurological injury. Both had non-diving-related arterial gas embolism. There was a good outcome in the majority of patients who presented with arterial gas embolism and were treated with compression.

September 15, 2008

Introductory Course in Hyperbaric Medicine and Wound Care

Filed under: Newsscubadoc @ 6:02 pm

 

Hello fellow heath care professional,

I want to notify you that The Department of Hyperbaric Medicine at Long Beach Memorial Medical Center is offering the upcoming following 40 CME-hour program:

Introductory Course in Hyperbaric Medicine and Wound Care
November 10-14, 2008

This course has been approved by the UHMS Education Committee as meeting the rigorous standards of a UHMS Designated Co-Sponsored Introductory Course in Hyperbaric Medicine.

The primary purpose of this program is to use both didactic and practical chamber-side teaching formats to introduce and educate physicians, with a background in a variety of specialties, in the theory, principles, and practices of hyperbaric medicine and wound care. Additionally, this CME program is designed to educate nursing, allied health professionals, and medical administrators who have educational interests or needs in hyperbaric medicine and wound care.

This course is expected to provide the participant with core knowledge about the theory and practices of hyperbaric medicine and wound care and to be a solid base for which further education and training in hyperbaric medicine and wound care can be built upon.

The faculty at LBMMC Department of Hyperbaric Medicine is uniquely qualified to provide this education. Members of our faculty include leaders in the field of hyperbaric medicine. We take advantage of our multi-specialty background (e.g., orthopedic surgery/wound care, emergency medicine, hematology/oncology, and pulmonary/critical care medicine) to provide a well-rounded perspective of the specialty.

The next course is scheduled to take place in Long Beach, California on:

November 10-14, 2008

Discounted hotel accommodation information is available upon request.

If you are interested in attending this course or would like more information, please see the attached brochure and fill out the accompanying registration form or contact:

Shari Hart at:

SHart@memorialcare.org

Department of Hyperbaric Medicine
Long Beach Memorial Medical Center
2801 Atlantic Ave.
Long Beach, CA 90806
(562) 933-6950

We look forward to seeing you in November.

Sincerely,

Department of Hyperbaric Medicine
Long Beach Memorial Medical Center

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September 8, 2008

Undercurrent Online Update

Filed under: News, Publicationscubadoc @ 8:53 am

Undercurrent — Consumer Reporting for

the Scuba Diving Community since 1975
www.undercurrent.org

Dive News

September 8, 2008

You have received this message because you have signed up on our website to receive this email or you are a former subscriber or Online Member of Undercurrent . Removal instructions are below.

A Nasty Case of Conjunctivitis: One of our free reads in the September issue — how 13 divers at a Fiji resort caught major pink eye. Here’s a hint: Watch where you put your mask. Read what happened and how to avoid conjunctivitis. Go to Undercurrent and click on the article in our September issue’s table of contents.

Hurricane Update: Hurricane Gustav hit the Caymans recently. Grand Cayman sustained little significant damage, but Little Cayman and Cayman Brac lost most of their docks, and dive hotels and condos had some damage, though all are reparable. On Little Cayman, dive boats were tossed onto shore. Over the weekend, Hurricane Ike pummeled the Turks and Caicos islands; at least 80 percent of the homes on Grand Turk were damaged. More hurricanes are coming and the prediction is they will get nasty. A tip of our hat goes to “ASmith2,” who mentioned a good Internet tracker on the Undercurrent forum last week. He recommends the Caribbean Storm Network (http://stormcarib.com) for divers with upcoming Caribbean trips - it gives the latest hurricane updates, and reports from local correspondents on every island. And get travel insurance!

The 480-page 2009 Travelin Divers Chapbook: We publish this each year, filled with hundreds of current reviews of dive resorts written by our subscribers, the most serious group of divers anywhere. If you become a print subscriber or Online Member, you too can have your report published, but you must do so now. Go to Undercurrent to become a subscriber or Online Member, then click on “Submit a Reader Report” at the top right to submit your report for the next chapbook - the deadline is September 24.

Dive Planner for iPhones and iPods: Rob Griffiths, a diver and editor for Macworld, gives a thumbs-up for Dive Planner, an electronic alternative to standard dive tables that is compatible with any iPhone or iPod touch running the iPhone 2.0 software update. “It’s a simple tool with three vertical sliders - Pressure Group, Depth and Minutes Down. A fourth horizontal slider lets you set the planned surface interval between dives. Two buttons toggle between readouts in feet or meters, and two boxes contain pressure group after the dive and after the indicated surface interval. Compared to using a dive table, this is simplicity in action.” And at $3, it’s a bargain. DivePlanner is based on the Navy Dive Tables and can be downloaded from the iTunes App Store.

Save the Mantas: You’re just about guaranteed to see manta rays if you dive Yap, and now that Micronesian island has passed a law protecting their habitat out to 12 miles offshore. The new manta ray reserve will be 8,243-square-mile area, comprising 16 islands and atolls.

Rescue Devices for Saving Your Bacon: Our other free article in this month’s issue is a review by our guest columnist, DIVER magazine’s technical editor John Bantin, about the role that certain types of rescue devices play if you’re lost at sea. Are flags better than flashlights? What about beacons with GPS? Read about those, plus what Bantin’s favorite rescue device is, by clicking on “Rescue Devices for Saving Your Bacon” in the September issue lineup on Undercurrent.

Aquariums Opening Their Tanks to Divers: As least eight aquariums, including those in Atlanta, Baltimore, Denver, and Tampa, allow divers to dive in their tanks, generally for a hefty fee. Atlantis Marine World Aquarium on Long Island opened a shark-dive program last June to anyone ages 12 and up - they’re in a cage and wear a full-face mask helmet. The aquariums say this gets people more interested in marine life and saving the oceans but Jean-Michel Cousteau questions the stress this puts on whales, sharks and the like enclosed in the tanks. Holdouts that refuse to offer paid dives include the New York Aquarium, Boston’s New England Aquarium and Chicago’s Shedd Aquarium.

Ambient Pressure Diving Hose Recall: Some hoses fitted to products from this UK company could be unsafe due to insufficiently crimped connector fittings. The fittings should be crimped so that eight flats are clearly visible on the fitting collar. If the collar is smoothly rounded, crimping has not been done. There is a risk of the hose fittings coming away from the hose. Potentially affected are low-pressure hoses used on Inspiration, Evolution and Evolution+ rebreathers; the Buddy Blast Hose (air horn end only); second stage regulator hose (second-stage end only); and gas connection system (second stage/ADV end only). Among the rebreathers, the hoses to examine are the ADV hose (ADV end only); buzzer hose (both ends); oxygen supply hose (solenoid end); and handset hose (lid end). It is thought that the problem relates to a small number of hoses made between April and July 2008, but APD suggests that customers who purchased hoses after January 2007 - either as part of another product or as a spare - check their hose-crimping. APD hoses that employ screw-together fittings are not affected by the recall. To obtain a replacement or make an inquiry, call 603-447-2600 or email Nicky@apdiving.com. More details about the products are at www.apdiving.com.

The Ring of Fire Cruise: Dr. Lawrence Blair, Indonesia expert and author and co-producer of the book and PBS documentary film Ring of Fire and more recently the series Myths, Magic and Monsters, has two remaining cabins available for an adventure cruise with 30 people aboard the luxury vessel Indies Trader IV (http://www.indiestrader.com/indiestrader09/indies4.html) to central Papua and the Raja Empat Islands off West New Guinea for October 11-24, 2008. It’s both an exploratory diving and cultural cruise, with a visit to the Asmat tribe, famous for its tribal art. The two double cabins cost (for a couple) $35,100 and U$ 32,500 respectively. If you have that kind of money, then you’ll be pleased to know that 10 percent of your fee will be donated to Undercurrent and our effort to save the reefs. For further details, e-mail RingOfFire@banjartamu.org, or go to http://www.banjartamu.org/LawrenceBlair.html.

In Case You Missed It Last Month:
The Undercurrent Online Divers’ Forum: We have launched an exciting, new feature on our website to help serious divers obtain the best, most complete and latest diving information: The Divers’ Forum. This forum offers the thousands of Undercurrent readers a means of directly communicating with each other. You can post questions or replies to others’ questions on virtually any aspect of diving. Unlike other forums, here you interact only with other Undercurrent subscribers and Online Members — as knowledgeable, well traveled, and experienced a group of serious divers as you’ll find anywhere. . . If you are not a current print subscriber or Online Member, you can become one in just a minute and get immediate access to the Forum and thousands of pages of solid dive info. Or if you’re a former Online Member, you can rejoin instantly using your old username and password here. Then log in and join in the dialogue at The Undercurrent Online Divers’ Forum.

What’s in the September Issue:

Read it online now - take advantage of our trial membership for just $1 for the first month. In this issue, you’ll find out about:

* Palau diving, is it better on land or a liveaboard;
* Palau dive shop Fish ‘n Fins’s special trips to remote dive sites aboard its Ocean Hunter boats;
* A closer look at the hazards of dive boat engine exhaust;
* Dive deals in the U.S. and South Pacific;
* Having trouble equalizing? Try sinus surgery;
* Part II of how a liability release hurts divers wanting to take legal action, and whether you can make any changes to that release;
* An Alabama dive instructor charged with homicide;
* Why you should stop chasing digital innovations in underwater camera gear…And much, much more.

Ben Davison, editor/publisher
Contact Ben

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September 5, 2008

DIVING RISK

Filed under: Articlescubadoc @ 5:19 pm

When asked about “risk” in scuba diving, one almost automatically thinks of ratios, percentages and comparisons with other activities. Various estimates are published, varying from a risk of 3% (3% of what?) estimate of causing death during a lifetime to one dive equaling certain known dangerous activities; such as 1.4 cigarettes, or 1 hour in a coal mine or eating 40 tablespoons of peanut butter. You can see the absurdity in trying to place numbers on any activity that could cause death or injury - but the insurance planners have to do this in order to apply a monetary value to their protection.

Scuba diving does not allow for accurate accounting of risk because we have only vague ideas of what numbers we should fit into any equation that we might want to use. We have incomplete figures for deaths and injuries (numerator)and absolutely no true values for how many dives are made over a period of time(denominator). This is all guesswork. Divers Alert Network makes a valiant (and intelligent) effort to do this every year in their publication, ‘Report on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2002 Edition’, but it should be apparent that their figures are incomplete for the general diving population.

I have long thought that a more sensible approach to assessing risk to the individual would be to identify factors that increase risks and to offer some guidelines to the diver for reduction of these risks. DAN’s follow-up and assessments of individual diving deaths comes the closest to offering this solution to the problem. Undercurrent Newsletter (www.undercurrent.org/) has long had a section on why divers die and other books and agencies use this method effectively,;e.g., Carl Edmonds book, Diving and Subaquatic Medicine.

An injured or dead diver represents a 100% statistic for that individual, and a study of “who, what, where when and why” often provides an insight into scuba risks that will not be found in any actuarial compendium. Risks arise from some identifiable hazard. A hazard is a source of danger, whether this is derived from the diver (host factors) or from external (environmental) factors. It seems to me that this can also be simplified into knowledge (training) and fitness (both physical and medical). Knowledge comes from training and experience. Types of fitness come from directed physical activity and from medical awareness of conditions dangerous to a diver under pressure.

On the positive side of the ledger (factors that decrease risk), knowledge of and sensible motivation to carry out activities that decrease risk include:

—Training and certification for the diving activity that is to be undertaken. (E.g., technical diving done by a diver who has only basic or advanced skills). In 10 years of DAN’s collection of diver fatalities, uncertified divers accounted for 7.7% (70) of the fatalities and students for 5.2% (47).

—Experience. This is a factor that cannot be quantified but which obviously decreases risk. (unless it leads to repeating the same mistake over and again).

—Being physically fit requires conscious effort and motivation from the knowledge that this will be beneficial.

—Good health or the absence of conditions that are adverse to diving. The diver should have knowledge that the diver does not have disorders that lead to altered consciousness, disorders that inhibit the “natural evolution of Boyle’s Law” or disorders that may lead to erratic and irresponsible behavior.

—Knowledge about the appropriate age of safe diving. Debatable, but there are many reasons why divers below 14 and above 70 should not dive.

—Knowledge of the positive effects of not smoking, using drugs and drinking alcohol

—Knowledge of the benefits of excellent, well-maintained equipment.

Negative factors increasing risks of diving include some or many of the following:

—Lack of proper (or no) certification for the dives undertaken. This includes clearing technique, ascent and deco technique. Poorly planned dives.

—Technical Diving (Inadequate knowledge for the dives undertaken) DAN’s collection of diver fatalities show recreationally certified divers making a technical dive accounted for 10.4% (95) of the fatalities.

—Commercial diving (a catch 22 of having to dive for a living but knowledge that prolonged work at depth can be detrimental, a whole ‘nother subject!)

—Hazards.

–Water –currents, surges, wave action, boat traffic, overhead diving (wrecks, caves)

–Weather

–Marine Life

—Buddy factor. A stranger or poorly trained buddy; buddy inadequate to rescue due age, strength or maturity. (Buddy separation occurred in 39.7% (362) of deaths and 14.4% (132) of divers were diving without a buddy).

—Equipment Malfunction. For whatever reason. This is rare.

—Air. Bad air, out of air, air never there. Happens more often than it should.

—Medical problems as outlined above (natural disease). Australian figures show that 9% of divers who die have been specifically advised by a diving medical expert or their dive instructor that they were unfit to dive. At least 25% of those who died while diving were medically unfit to dive and should not have been doing so.

—Cognizant/psychiatric problems. Diminished mentation from whatever cause. Mental illness, drugs, buccaneers.

—Age factors (see above) Knowledge and mentality to apply that information.

Interesting information is gleaned from ten years of diving fatality epidemiology: Divers Alert Network database, 1989-1998. Figures indicate that for the 912 diving fatalities a thorough investigation usually reveals a critical error in judgment or a violation of recommended safe diving procedures. (James Caruso, MD, in Journal of the Marine Medical Society, India,)

Dr. Caruso has also noted that in the 1995 review of this data, there are several recurring themes associated with fatal recreational diving accidents. He states, “Divers with little or no experience in more challenging types of diving are disproportionately represented in the DAN diving fatality database. Common causal and contributing factors include running out of air, cardiovascular disease, and buddy separation. Emphasizing increased training and experience, identifying significant pre-existing natural disease processes, and adhering to the recommended diving safety guidelines should reduce the annual number of diving fatalities.”

So it seems to boil down to knowledge and the application of that knowledge as the prime factors in risk management of diving injuries and fatalities. Of course, one cannot teach intelligence or common sense - but it would appear that our teaching agencies are all generally doing a good job in the training sphere, with the possible exception of the training of children.

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September 3, 2008

Latest Issue of XRAY International Dive Magazine

Filed under: Uncategorizedscubadoc @ 3:29 pm

<http://www.xray-mag.com/Directory>

<http://www.xray-mag.com/Latestissue>

Download Latest Issue NOW! <http://www.xray-mag.com/Latestissue>
Find 102 Full Spreads In Our Latest Issue

X-RAY MAG issue #25 is out now!

Dive into South Africa where Andrey Bizyukin visits the Wild Coast,
Ralf Kiefner takes awesome photographs of Sardine Run, and Harald
Apelt profiles Rainer Schimpf’s adventure playground for experts in
Port Elizabeth where first-ever images capture orcas hunting dolphins!

Apelt also takes us to another Mediterranean pearl — Tamariu of
Spain, while Simon Kong reports on MIDE and shows us paradise reborn
on Pulau Weh, Aceh, Indonesia, after the 2004 tsunami, with colorful
photographs by Asther Lau.

Arnold Weisz highlights some of the success stories in marine
conservation, while Swedish Coast Guard Commander Carl-Gustav von
Konow discusses diving with dumped chemical weapons in the Baltic.

Cedric Verdier offers an excellent Buyer’s Guide to Rebreathers full
of tips and advice.

Kurt Amsler shows us how to maintain and care for our underwater
photography gear, and Tim Hochgrebe brings us the winners of
Underwater.com.au’s photo competition.

GirlDiver Cindy Ross takes on the challenge of the Mark V Hard
Helmet.

Explore Molnar Janos cave under the streets of Budapest with JP
Bresser, and view the exquisite portfolio of stainless steel sculptor
and diver, Jo Wooler of Australia.

Click here to go to our download-page (pdf)
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