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Previous trials of flying at 8,000 ft after a single 60 fsw, 55 min no-stop air dive found low decompression sickness (DCS) risk for a 11:00 preflight surface interval (PFSI). Repetitive 60 fsw no-stop dives with 75 and 95 min total bottom times found 16:00. Trials reported here investigated PFSIs for a 60 fsw, 40 min no-stop dive and a 60 fsw, 120...
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Altitude decompression sickness (DCS) is a health risk associated with the conduct of high altitude airdrop operations, high altitude reconnaissance, future fighter operations, hypobaric chamber training, unpressurized flight, and extravehicular activity (EVA) in space. The treatment for DCS includes the provision of 100% oxygen (O2) at ground leve...
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... Taucher mit dekompressionspflichtigen Tauchgängen sollten 24 Stunden, besser 48 Stunden vor dem Heimflug nicht getaucht haben. In den Jahren danach folgten verschiedene Studien mit simulierten Flügen in Unterdruckkammern und die Auswertung von Tauchunfällen aus der Datenbank des Divers Alert Network (DAN) [6][7][8][9]. Ergebnisse dieser Untersuchungen zeigten, dass nach jedem Tauchgang sogenannte " stumme Blasen " (Mikroblasen, " microbubbles " ) vorhanden sind. Tauchen Gasblasen wurden dabei nach Eftedal und Brubakk eingeteilt und die Taucher während der Tauchwoche in 3 Gruppen eingeteilt: @BULLET ohne Blasenbildung (Non-Bubblers, NB), @BULLET gelegentliche Blasenbildung (Occasional Bubblers, OB) und @BULLET immer Blasenbildung (Bubblers, B). ...
Flying and diving – Updated knowledge about intervals without diving
ahead and after flights
Although many interesting diving spots are located in Germany, most spots
require a previous airline flight. As early as in the first hours of an open water
diver course, beginners learn that flying and diving may interfere. Not only
the flight back home may cause problems, also the flight to the diving spot
may increase the risk of diving-related problems.
Especially dehydration as well as jet lag can cause accidents. While recent
guidelines of the „undersea and hyperbaric medical society“ (UHMS) request
an interval of 24 hours before the flight back, 18-24 hours are considered
adequate in praxi. Recent literature suggests 36 hours before a flight.
... These prevention efforts include diving education and use of dive computers, oxygen-enriched-air, flying after diving guidelines, conservative diving practices, first-aid surface oxygen and banning emergency free ascent during training dives. [31][32][33][34][35][36] However, most fatalities occur due to causes other than DCS or AGE. 8,10 Behavioral interventions allow divers to actively participate in ensuring their own safety. ...
Background : Scuba diving mishaps, caused by equipment problems or human errors, increase the occurrence of injuries and fatalities while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers.
Methods : A multi-location cluster-randomized trial with parallel groups and allocation concealment was conducted between 1 June and 17 August 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received a pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates per 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol and marginal structural model analyses were conducted.
Results : A total of 1043 divers (intervention = 617; control = 426) made 2041 dives, on 70 location-days (intervention = 40; control = 30) at four locations. Compared with the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26% and all mishaps by 32%. On average, there was one fewer mishap in every 25 intervention dives.
Conclusions : In this trial, pre-dive checklist use prevented mishaps which could lead to injuries and fatalities. Pre-dive checklists can increase diving safety and their use should be promoted.
Trial Registration : ClinicalTrials.gov ID NCT01960738.
... DCS can occur after rapid decompression to altitude, e.g., in a military jet, hypobaric chamber or during flight in a commercial aircraft with accidental loss of pressure. DCS after a dive can be provoked by mild altitude exposure, such as a commercial aircraft flight [17,57], but without a preceding dive the threshold altitude for DCS occurrence is approximately 20,000 feet [62,63]. ...
Decompression sickness (DCS) is a clinical syndrome occurring usually within 24 hours of a reduction in ambient pressure. DCS occurs most commonly in divers ascending from a minimum depth of 20 feet (6 meters) of sea water, but can also occur during rapid decompression from sea level to altitude (typically > 17,000 feet / 5,200 meters). Manifestations are one or more of the following: most commonly, joint pain, hypesthesia, generalized fatigue or rash; less common but more serious, motor weakness, ataxia, pulmonary edema, shock and death. The cause of DCS is in situ bubble formation in tissues, causing mechanical disruption of tissue, occlusion of blood flow, platelet activation, endothelial dysfunction and capillary leakage. High inspired concentration of oxygen (O2) is recommended as first aid for all cases and can be definitive treatment for most altitude DCS. For most other cases, hyperbaric oxygen is recommended,most commonly 100% O2 breathing at 2.82 atmospheres absolute (U.S.Navy Treatment Table 6 or equivalent). Additional treatments (generally no more than one to two) are used for residual manifestations until clinical stability; some severe cases may require more treatments. Isotonic, glucose-free fluids are recommended for prevention and treatment of hypovolemia. An evidence-based review of adjunctive therapies is presented.
Hyperbaric oxygen for decompression sickness: 2021 update Decompression sickness (DCS, “bends”) is caused by the formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during: ascent from a dive; rapid ascent to altitude in an unpressurized aircraft or hypobaric chamber; loss of cabin pressure in an aircraft [2]; and during space walks. In diving, compressed-gas breathing is usually necessary, although occasionally DCS has occurred after either repetitive or very deep breath-hold dives
Decompression sickness (DCS, "bends") is caused by formation of bubbles in tissues and/or blood when the sum of dissolved gas pressures exceeds ambient pressure (supersaturation). This may occur when ambient pressure is reduced during any of the following: ascent from a dive; depressurization of a hyperbaric chamber; rapid ascent to altitude in an unpressurised aircraft or hypobaric chamber; loss of cabin pressure in an aircraft [2] and during space walks.
Techniques for ultrasonic assessment of decompression stress continue to evolve in concert with technological development. While aural Doppler remains a staple, imaging techniques are gaining in popularity. Current initiatives to increase the resolution of three-dimensional and dual-frequency imaging hold promise to expand our monitoring capabilities. An appreciation of the limitations and strengths of ultrasonic assessment is important to interpret existing work on decompression and to appropriately design new studies.
Gas can enter arteries (arterial gas embolism) due to alveolar-capillary disruption (caused by pulmonary overpressurization, e.g., breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is sub-atmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces strokelike manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries. However, VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patent foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence-based review of adjunctive therapies is presented.
Since its introduction in 1991, skin-sparing mastectomy has emerged as an acceptable surgical technique in the management of breast cancer patients, providing optimal oncological safety and efficacy with favorable aesthetic results. Rates of native skin flap ischemia and necrosis after skin-sparing mastectomy are 2%-30% and result in a decreased aesthetic outcome and delay of necessary adjuvant treatment. Hyperbaric oxygen therapy has been advocated for the management of various compromised flaps, and when instituted immediately postoperatively, may prevent progression of ischemia into necrosis. We report the case of a 41-year-old female who developed skin flap ischemia after undergoing skin-sparing mastectomy and was immediately treated with hyperbaric oxygen. The patient received a total of five hyperbaric oxygen therapy sessions, achieving full resolution of the ischemia without any complications. Further research is essential to determine the role of hyperbaric oxygen therapy in managing skin flap ischemia post skin-sparing mastectomy. Until such studies exist, hyperbaric oxygen therapy may be considered a preferred option in the management of native skin flap ischemia after skin-sparing mastectomy.
Objective:
The present study aimed to assess the effect of intensive rehabilitation combined with hyperbaric oxygen (HBO2) therapy on gross motor function in children with cerebral palsy (CP).
Methods:
We carried out an open, observational, platform-independent study in 150 children with cerebral palsy with follow-up over eight months to compare the effects of standard intensive rehabilitation only (control group n = 20) to standard intensive rehabilitation combined with one of three different hyperbaric treatments. The three hyperbaric treatments used were: air (FiO2 = 21%) pressurized to 1.3 atmospheres absolute/atm abs (n = 40); 100% oxygen pressurized at 1.5 atm abs (n = 32); and 100% oxygen, pressurized at 1.75 atm abs (n = 58). Each subject assigned to a hyperbaric arm was treated one hour per day, six days per week during seven weeks (40 sessions). Gross motor function measure (GMFM) was evaluated before the treatments and at two, four, six and eight months after beginning the treatments.
Results:
All four groups showed improvements over the course of the treatments in the follow-up evaluations (p < 0.001). However, GMFM improvement in the three hyperbaric groups was significantly superior to the GMFM improvement in the control group (p < 0.001). There was no significant difference between the three hyperbaric groups.
Conclusion:
The eight-month-long benefits we have observed with combined treatments vs. rehabilitation can only have been due to a beneficial effect of hyperbaric treatment.
Objective: The present study aimed to assess the effect of intensive rehabilitation combined with hyperbaric oxygen (HBO2) therapy on gross motor function in children with cerebral palsy (CP). Methods: We carried out an open, observational, platform-independent study in 150 children with cerebral palsy with follow-up over eight months to compare the effects of standard intensive rehabilitation only (control group n = 20) to standard intensive rehabilitation combined with one of three different hyperbaric treatments. The three hyperbaric treatments used were: • air (FiO2 = 21%) pressurized to 1.3 atmospheres absolute/atm abs (n = 40); • 100% oxygen pressurized at 1.5 atm abs (n = 32); and • 100% oxygen, pressurized at 1.75 atm abs (n = 58). Each subject assigned to a hyperbaric arm was treated one hour per day, six days per week during seven weeks (40 sessions). Gross motor function measure (GMFM) was evaluated before the treatments and at two, four, six and eight months after beginning the treatments. Results: All four groups showed improvements over the course of the treatments in the follow-up evaluations (p <0.001). However, GMFM improvement in the three hyperbaric groups was significantly superior to the GMFM improvement in the control group (p <0.001). There was no significant difference between the three hyperbaric groups. Conclusion: The eight-month-long benefits we have observed with combined treatments vs. rehabilitation can only have been due to a beneficial effect of hyperbaric treatment.
