scubadoc Ten Foot Stop

December 26, 2008

HBOT and the Eye

Filed under: Uncategorizedscubadoc @ 1:51 pm

Undersea Hyperb Med. 2008 Sep-Oct;35(5):333-87.Links

Comment in:
Undersea Hyperb Med. 2008 Sep-Oct;35(5):331-2.

Hyperbaric oxygen therapy and the eye.

Butler FK Jr, Hagan C, Murphy-Lavoie H.

Navy Medical Lessons Learned Center, Naval Operational Medicine Institute, Pensacola, FL, USA.

Hyperbaric oxygen therapy (HBOT) is a primary or adjunctive therapy for a variety of medical disorders including some involving the eye. This paper is the first comprehensive review of HBOT for ocular indications. The authors recommend the following as ocular indications for HBOT: decompression sickness or arterial gas embolism with visual signs or symptoms, central retinal artery occlusion, ocular and periocular gas gangrene, cerebro-rhino-orbital mucormycosis, periocular necrotizing fasciitis, carbon monoxide poisoning with visual sequelae, radiation optic neuropathy, radiation or mitomycin C-induced scleral necrosis, and periorbital reconstructive surgery. Other ocular disorders that may benefit from HBOT include selected cases of ischemic optic neuropathy, ischemic central retinal vein occlusion, branch retinal artery occlusion with central vision loss, ischemic branch retinal vein occlusion, cystoid macular edema associated with retinal venous occlusion, post-surgical inflammation, or intrinsic inflammatory disorders, periocular brown recluse spider envenomation, ocular quinine toxicity, Purtscher’s retinopathy, radiation retinopathy, anterior segment ischemia, retinal detachment in sickle cell disease, refractory actinomycotiC lacrimal canaliculitis, pyoderma gangrenosum of the orbit and refractory pseudomonas keratitis. Visual function should be monitored as clinically indicated before, during, and after therapy when HBOT is undertaken to treat vision loss. Visual acuity alone is not an adequate measure of visual function to monitor the efficacy of HBOT in this setting. Ocular examinations should also include automated perimetry to evaluate the central 30 degrees of visual field at appropriate intervals. Interpretation of the literature on the efficacy of HBOT in treating ocular disorders is complicated by several factors: frequent failure to include visual field examination as an outcome measure, failure to adequately address the interval from symptom onset to initiation of HBOT, and lack of evidence for optimal treatment regimens for essentially all ocular indications. Because some ocular disorders require rapid administration of HBOT to restore vision, patients with acute vision loss should be considered emergent when they present. Visual acuity should be checked immediately, including vision with pinhole correction. If the patient meets the criteria for emergent HBOT outlined in the paper, normobaric oxygen should be started at the highest inspired oxygen fraction possible until arrangements can be made for HBOT.

Other Links about diving and the eye

  1. Diving and the Eye

    Identifies eye problems that are associated with scuba diving.
    www.scuba-doc.com/diveye.htm - 75k - Cached - Similar pages

  2. Fitness to Dive: Eye

    The eye ball is fluid filled and changes in pressure are experienced equally throughout theeye. Any gas in the eye will be affected by pressure changes as 
    www.scuba-doc.com/fitdiveeye.html - 77k - Cached - Similar pages

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December 23, 2008

Dysbaric osteonecrosis in experienced dive masters and instructors.

Filed under: Uncategorizedscubadoc @ 12:16 pm

Aviat Space Environ Med. 2007 Dec;78(12):1150-4.

Cimsit M, Ilgezdi S, Cimsit C, Uzun G.

Department of Underwater and Hyperbaric Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey.

INTRODUCTION: Dysbaric osteonecrosis (DON) is a type of aseptic bone necrosis of long bones such as the humerus, femur, and tibia. It is observed in workers who perform in high-pressure environments. METHODS: There were 58 volunteer divers included in this study who had performed at least 500 dives, were working as a dive master or instructor, had never performed industrial and commercial dives, and did not have a diagnosis of osteonecrosis. Radiological evaluation was performed according to the guidelines suggested by The British Research Council Decompression Sickness Panel. A total of eight X-rays were taken per patient. When suspicious lesions were detected, MRI of the region was performed. RESULTS: Of the 58 divers, 2 were eliminated because of inadequate X-ray studies. A total of 18 DON lesions were detected in 14 of 56 (25%) divers. Age was the only variable independently associated with the development of DON (P < 0.05). DISCUSSION: The DON prevalence of 25% in this study is high considering the dive instructors had thorough diving training and strictly practiced the decompression rules. We believe this high prevalence is a result of frequent and sometimes deep dives for many years. Our findings raise the question of whether these divers can be seen as “sports divers” or should be seen as “occupational divers.” If the latter description is approved, dive masters and instructors should be kept under periodic screening for DON lesions just like professional commercial divers to help reduce the morbidity associated with this disease.

More about DON at

http://www.scuba-doc.com/osteonecrosis.pdf

Disease Transmission Using Scuba Gear

Filed under: Uncategorizedscubadoc @ 12:13 pm

Disease Transmission from Gear
Download PDF Format Free Download


Transmission of disease via scuba gear probably does not happen often — but the thought arises in the minds of those who fear using rental scuba gear or buddy breathing. There are many transmissable diseases that have the capability of being passed on to another through the use of unclean equipment. These conditions are caused by viruses, bacteria and fungi - some short-lived on inanimate objects, and some lurking and living in the moist confines of the crevices and tubes of unwashed scuba gear. Included among the viruses are HIV, HCV (Hepatitis C), influenza and herpes simplex. Bacterial infections include staphylococcus aureus, salmonella choleraesuis, pseudomonas aeruginosa, klebsiella pneumoniae and mycobacteris (tuberculosis); fungal infections include candida albicans.

The specter of getting HIV from CPR practice dummies has even caused a study to be done — with live HIV virus. This study conclusively showed  the use of routine cleansing methods (Propanol) to be effective in removing all traces of virus.

HIV is not spread by casual contact, such as shaking hands, hugging, touching objects handled by a person with AIDS, or by spending time in the same house, business, or public place. HIV is not spread by mosquitos or through food handled by a person with HIV. There is absolutely no risk of getting HIV from donating blood. HIV dies quickly outside the body and easily killed by soap and by common cleansers and disinfectants such as bleach.


Buddy Breathing

This time-honored safety technique apparently is not even being taught in some courses.  One wonders how much the HIV/AIDS epidemic has had to do with it’s near demise. Here presented is a very good discussion of disease transmission risk by Larry “Harris” Taylor, Ph.D., Scuba Instructor, U of MI:

“Most people are concerned about HIV (AIDS) and herpes. That’s fine …but the reality is that, for the most part, these disease causing critters are fairly weak and not terribly robust. The major concern, as I understand it, is hepatitis  … a far more robust virus and one known to survive in saliva.

We believe buddy breathing is an essential survival skill … by the end of our term, the students routinely are buddy breathing without mask, without one fin, and with the tank unsecured.  Even though we believe the risk in a chlorine pool to be small, it is NOT zero. SO, we conduct our buddy breathing single regulator exchange exercises in the following manner:

The regulators are initially configured so that both come over the student’s right shoulder. The octopus regulator has a longer hose. Prior to initiation of practice, the octopus regulator is removed from its holder … its hose is placed through the space on the primary regulator that runs between the exhaust housing and the body of the regulator. This places the regulators side-by-side. The donor breathes off the primary … the recipient breathes off the secondary. In this manner, the exchange process, the blowing bubbles while regulator is out of the mouth, the rhythm of the exchange and ability to swim and ascend while doing a single regulator exchange can be practiced. Since divers are breathing off different regulators, the risk of disease transmission is much lower than breathing from a common reg. It is the closest simulation that we have been able to develop. By the way, there are vaccinations available for hep B … its a good idea for those dealing with lots of exposures to humans to consider these shots (mine was a series of three spaced over several months)– “

Addendum: It is probably not a good idea for the diver infected with HIV to take the Hepatitis B vaccine.  When possible, live virus vaccines should be avoided in persons who are infected with HIV. Gastrointestinal illnesses may be more frequent and severe than in other travelers. Food and water precautions, and a treatment course of an antibiotic will minimize the risk of severe disease. Many diseases, such as tuberculosis, leishmaniasis, and syphilis are more common and/or severe in immunocompromised hosts. HIV-infected travelers should be instructed to seek medical attention for pulmonary symptoms or fevers.


Rental Gear

This might be a problem if a dive shop had a large HIV positive clientele. However, the HIV virus is somewhat fragile, does not live long in saliva (due to immune globulins), and certainly would not seem to pose a hazard unless there had been blood admixture. Any risk at all would be due to the possibility of bleeding from regulator or snorkel injury to the gums or nosebleeds into the mask. It is this possibility that should cause dive shops to have a protocol of rental gear cleansing and sterilization. Let me finish by saying that there have been no reported cases of HIV infection by the transmission of saliva.  Transmission must go directly from one person to the other very quickly ….the virus does not survive more than a few minutes outside the body. Human bites with blood, yes — but none with coughing, openmouthed kissing, CPR dummies, or scuba gear.

Links

Cleaning scuba gear 

Undersea Hyperb Med. 2008 May-Jun;35(3):169-74.Links

Conjunctivitis outbreak among divers.

Olsson DJ, Grant WD, Glick JM.

Department of Emergency Medicine, State University of New York, Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.

In March 2006, an outbreak of conjunctivitis that occurred over a six day period among twenty-nine individuals who partook in recreational scuba diving trips on two boats off Vitu Levu Island, Fiji. We investigated the likelihood that a communal container used to store diving masks facilitated the spread of conjunctivitis among individuals. The diagnosis of conjunctivitis was based on clinical assessment by a physician. Transmission of conjunctivitis from person to person was documented with eventual identification of the index case, the dive master, a Fijian resident. Topical antibiotics were dispensed accordingly and detergent and bleach were used as mask cleaning agents in an effort to control the outbreak. Follow up surveys were mailed to all twenty-nine participants. Ultimately, fourteen cases of conjunctivitis were documented (46.7%). Eleven cases were verified during the six days in Fiji, two upon arrival back in the U.S., and one case of familial transmission in the U.S. All but two cases resolved within one week. Unknown to these divers was a coincidental, generalized outbreak of acute haemorrhagic conjunctivitis among the Fijian Residents. The communal container used to store diving masks was the likely vector for the spread of infectious conjunctivitis, the first such documented outbreak involving communal diving equipment.

December 20, 2008

Dr Sanjay Narmala, a Diving physician located in Mumbai India

Filed under: News, Uncategorizedscubadoc @ 12:10 pm

Dear Sir,

I would like to introduce by self I am Dr Sanjay Narmala , a Diving physician located in Mumbai India, I have done Diving Medical Training from University of Aberdeen. Recently I have been enrolled by John Lippmann of DAN -Asia pacific as Medical advisor & referral physical to Divers Alert Network (DAN)-Asia pacific in India. Sir presently I am reading your book titled ” Assessment of Diving medical Fitness for Scuba Divers & Instructors”. This book is very simplified & easy to understand, More informative, thanks for giving us such a wonderful book. I am regular reader of Diving Medicine online & ten foot stop blogs.

Mainly I am dealing with commercial divers but now started dealing & involving in recreation divers as we have some proportion of scuba divers & they are in need of Diving Medical advice too.

Sir I would like to be included in Diving Physician list under Indian Hyperbaric facilities. I would highly appreciate if you consider for it.

Looking forward to hear from your soon.

Thanks in advance

Best Regards,

Dr. SANJAY P. NARMALA
M.B.B.S, C.U.M (ABERDEEN,UK),F.R.S.H(LON)
Consultant  Underwater & Hyperbaric Medicine.

Medical Advisor-Divers Alert Network(DAN)-Asia Pacific

“AQUAMED”

B-510, Rustomji C.H.S Ltd, Western Express Highway,

Near Silver Group Landmark Bldg & Cinemax.

Chakala, Andheri(E), Mumbai 400093, INDIA.

Ph: +91 98193-46046

      +91 93202-46046

Email: sanjay@divemedicals.com

          drnsanjay@yahoo.co.uk

Web: http://www.aquamed.in/

         http://www.divemedicals.com/

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Fiji “Dive Away” Diving Medicine Program

Filed under: Uncategorizedscubadoc @ 12:07 pm

Dear Divers, diving medicine enthusiasts and guests

ADVANCED NOTICE:  Fantastic up-coming “Dive Away” Diving Medicine Program and dive package:

Mark your calendar and get ready for our 18th International Diving, Diving-Medicine Program, jointly sponsored by the department of hyperbaric medicine at Long Beach Memorial Medical Center, the Undersea and Hyperbaric Medical Society, and the American College of Emergency Physicians. 

-   August 27 – September 5, 2009      FIJI, South Pacific

-   Nationally/internationally recognized faculty presenting CME diving medicine program.

-   Secluded island paradise, accommodations at a beachside all-inclusive resort, spectacular diving, great price….

-   Confirm plans today….there is limited availability and this program will sell out!

We look forward to you joining us in Fiji,

The Dive Team

Long Beach Memorial Medical Center

More Info: Shari Hart (562) 933-6950 or Dr. Alan Lewis at drbabar77@gmail.com

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December 9, 2008

Double vision due to decreased mask pressure in a diver

Filed under: Article, Newsscubadoc @ 4:40 pm

Diplopia due to mask barotrauma.

Latham Evan Hoesen KGrover I.

Department of Emergency Medicine, Division of Hyperbaric Medicine, University of California, San Diego, San Diego, California.

J Emerg Med. 2008 Nov 6. [Epub ahead of print]

Background: Scuba diving is a very popular and safe sport. Occasionally divers will suffer an injury from barotrauma, decompression sickness or an arterial gas embolism. The history and physical examination are important when determining the etiology of the injury and its subsequent treatment. Objectives: This article will help readers identify key components of the history and physical examination in a patient to help differentiate between and injury caused by barotrauma or arterial gas embolism. Case Report: This is a case of a diver that was initially felt to have an arterial gas embolism after scuba diving. After obtaining further history and performing a detailed physical exam it was determined that his diplopia was due to barotrauma from his mask. This was confirmed by an orbital computed tomography (CT) scan. Summary: Scuba diving is a very safe sport. When injuries occur it is important to obtain a careful history and physical examination to determine the exact cause of the injury because treatments vary according to the type of injury. In this case, the history and physical examination showed that the only neurologic sign the patient had was diplopia, which is not consistent with a diagnosis of arterial gas embolism. The CT scan helped with the diagnosis because it proved the patient had an orbital hematoma causing his proptosis and double vision.

PMID: 18993013 [PubMed - as supplied by publisher]

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Interesting Study on Pressure inside the Eyeball while Diving

Filed under: Article, Newsscubadoc @ 4:34 pm

Influences of atmospheric pressure and temperature on intraocular pressure.   
MED   08-59   200818641290  NDN- 230-0878-7598-8

AUTHORS- Van de Veire, Sara; Germonpre, Peter; Renier, Charlotte; Stalmans, Ingeborg; Zeyen, Thierry

JOURNAL NAME- Invest Ophthalmol Vis Sci
VOLUME 49
NUMBER 12
PUBLICATION DATE- 2008 Dec
PP 5392-6
DOCUMENT TYPE- Journal Article
JOURNAL CODE- 7703701
JOURNAL SUBSET- MEDJSIM
ISSN- 1552-5783
CORPORATE AUTHOR- Department of Ophthalmology, Catholic Universities Leuven, Leuven, Belgium.
PUBLICATION COUNTRY- United States
LANGUAGE- English

PURPOSE: To determine whether the atmospheric pressure (ATM) change experienced during diving can induce changes in the intraocular pressure (IOP) of eyes in a normal population. METHODS: The IOP of 27 healthy volunteers (ages, 23.8 +/- 4.9 years; range, 18-44) was measured with a Perkins applanation tonometer by two independent investigators who were masked to the previous measurements. Measurements were taken at baseline (normal ATM, 1 Bar and 24 degrees C), at 28 degrees C and 24 degrees C after the ATM was increased to 2 Bar in a hyperbaric chamber , at baseline again, and finally at the normal ATM of 1 Bar but a temperature of 28 degrees C. Multivariate regression analysis was used to evaluate the RESULTS: results. The mean IOP decreased significantly from 11.8 mm Hg in the right eye (RE) and 11.7 mm Hg in the left eye (LE) at 1 Bar to 10.7 mm Hg (RE) and 10.3 mm Hg (LE) at 2 Bar (P = 0.024, RE; P = 0.0006, LE). The IOP decrease remained constant during the ATM increase period (40 minutes) and was independent of the temperature change. The temperature increase alone did not significantly influence the IOP. CONCLUSIONS: An increase of the ATM to 2 Bar (equal to conditions experienced during underwater diving at 10 meters) modestly but significantly decreased the IOP independently of the temperature change. During the period of increased ATM (60 minutes), the IOP decrease remained stable and was independent of blood pressure change or corneal thickness.

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December 4, 2008

2009 Winter Symposium on Hyperbaric Medicine and Wound Management

Filed under: Newsscubadoc @ 4:51 pm

2009 Winter Symposium on Hyperbaric Medicine and Wound Management

Beaver Run Resort, Breckenridge, CO

January 25th - 27th, 2009

 

Sponsored by Memorial Hospital, Colorado Springs, Colorado

 

Course Directors:  James Holm, MD & Takkin Lo, MD

 

We are pleased to announce return of the Winter Symposium!  We are attempting to go to an every other year conference now.

 

The 2009 Winter Symposium will be held at Beaver Run Resort, Breckenridge, CO, from January 25th to 28th, 2009.  Approximately 16.5 hours of credits for physicians, nurses and CHTs will be available.

 

This year’s conference will focus on hyperbaric medicine, wound care, undersea medicine, and administrative issues of interest.   We will have a “hands on” session dealing with Negative Pressure Wound Therapy and Living Skin Substitutes.  

 

Flights to Denver are very reasonable and we have negotiated hotel room rates starting at $149 per night at this slope side resort.  Click here for Hotel Info.

 

More information is available at the conference website at www.hbodoctor.com or thru the links below.

 

Click here for the Conference Homepage

 

Click here for the Conference Agenda

 

Click here for the “Call for Abstracts”

 

 

For Information to Exhibit or Sponsor, please click on the link below:

 

Click here for information regarding Exhibitors or Sponsors

 

 

Hope to see you there.  For more information please feel free to contact Dr. Jim Holm at hbodoctor@yahoo.com or Brandy Swennes (Memorial CME) at brandy.swennes@memorialhealthsystem.com

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