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For the purposes of this guideline, a diving accident is defined as an event that is either potentially life-threatening or hazardous to health as a result of a reduction in ambient pressure while diving or in other hyperbaric atmospheres with and without diving equipment. This national consensus-based guideline (development grade S2k) presents the current state of knowledge and recommendations on the diagnosis and treatment of diving accident victims. The treatment of a breath-hold diver as well as children and adolescents does not differ in principle.In this regard only unusual tiredness and itching without visible skin changes are mild symptoms.The key action statements: on-site 100% oxygen first aid treatment, immobilization/no unnecessary movement, fluid administration and telephone consultation with a diving medicine specialist are recommeed.Hyperbaric oxygen therapy (HBOT) remains unchanged as the established treatment in severe cases, as there are no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa.

Study Objective: Application of high concentrations of oxygen to increase oxygen partial pressure (pO2) is the most important treatment for patients with carbon monoxide intoxication or divers with suspected decompression illness. The aim of this study was to evaluate the oxygenation performance of various non-invasive oxygen systems. Methods: The effect of different oxygen systems on arterial pO2, pCO2 and pH and their subjective comfort was evaluated in 30 healthy participants. Eight devices were included: nasal cannula, non-rebreather mask, AirLife Open mask, Flow-Safe II CPAP device, SuperNO2VA nasal PAP device, all operated with 15 L/min constant flow oxygen; nasal high-flow (50 L/min flow, 1.0 FiO2), non-invasive positive pressure ventilation (NPPV, 12 PEEP, 4 ASB, 1.0 FiO2) and a standard diving regulator (operated with pure oxygen). Results: Diving regulator, SuperNO2VA, nasal high-flow and NPPV achieved mean arterial pO2 concentrations between 538 and 556 mm Hg within 5 minutes. The AirLife Open mask, the nasal cannula and the non-rebreather mask achieved concentrations of 348–451 mm Hg and the Flow-Safe II device 270 mm Hg. Except for the AirLife open mask, pCO2 decreased and pH increased with all devices. The highest pH values were observed with NPPV, diving regulator, Flow-Safe II and nasal high-flow but apparent hyperventilation was uncommon. The AirLife Open and the non-rebreather mask were the most comfortable, the SuperNO2VA and the nasal cannula the most uncomfortable devices. Conclusion: A standard diving regulator and the SuperNO2VA device were equally effective in providing highest physiologically possible pO2 as compared to nasal high-flow and NPPV. [ABSTRACT FROM AUTHOR]

Study Objective: Application of high concentrations of oxygen to increase oxygen partial pressure (pO2) is the most important treatment for patients with carbon monoxide intoxication or divers with suspected decompression illness. The aim of this study was to evaluate the oxygenation performance of various non-invasive oxygen systems.Methods: The effect of different oxygen systems on arterial pO2, pCO2 and pH and their subjective comfort was evaluated in 30 healthy participants. Eight devices were included: nasal cannula, non-rebreather mask, AirLife Open mask, Flow-Safe II CPAP device, SuperNO2VA nasal PAP device, all operated with 15 L/min constant flow oxygen; nasal high-flow (50 L/min flow, 1.0 FiO2), non-invasive positive pressure ventilation (NPPV, 12 PEEP, 4 ASB, 1.0 FiO2) and a standard diving regulator (operated with pure oxygen).Results: Diving regulator, SuperNO2VA, nasal high-flow and NPPV achieved mean arterial pO2 concentrations between 538 and 556 mm Hg within 5 minutes. The AirLife Open mask, the nasal cannula and the non-rebreather mask achieved concentrations of 348–451 mm Hg and the Flow-Safe II device 270 mm Hg. Except for the AirLife open mask, pCO2 decreased and pH increased with all devices. The highest pH values were observed with NPPV, diving regulator, Flow-Safe II and nasal high-flow but apparent hyperventilation was uncommon. The AirLife Open and the non-rebreather mask were the most comfortable, the SuperNO2VA and the nasal cannula the most uncomfortable devices.Conclusion: A standard diving regulator and the SuperNO2VA device were equally effective in providing highest physiologically possible pO2 as compared to nasal high-flow and NPPV.

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy “Dauphin” or at a landing zone by an emergency unit EC 135 helicopter. METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyères (France) Naval Air Station, and the “SAMU 83” emergency unit (Toulon, France). RESULTS: A total of 23 diving accidents were evacuated offshore by “Dauphin” helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest. DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE. [ABSTRACT FROM AUTHOR]

When commercial sea harvesters have dive accidents, it is sometimes difficult to obtain an accurate dive history and make a definitive diagnosis. We report a sea harvest diver who dived to collect sea snails (Rapana venosa) by using a hookah dive system. He experienced mediastinal and subcutaneous emphysema due to interruption of breathing airflow. Thoracic computed tomography performed one year prior to the accident revealed paramediastinal subpleural blebs on both lung apices. Emphysema was resolved by administering normobaric oxygen. [ABSTRACT FROM AUTHOR]

Abstract Background Even in a landlocked country like Switzerland recreational diving is becoming more and more popular. Smaller lakes in the Alps are located at an altitude of 2500 m above sea level. The incidence of diving accidents among all helicopter emergency service missions and the consecutive medical knowledge about decompression injuries is low. Thus, a collaboration between the Swiss Air-Ambulance (Rega) and the divers alert network (DAN) was initiated to improve patient treatment and identification of decompression injury and necessity of hyperbaric oxygen therapy (HBO). Methods Retrospective observational study that includes all patients treated by the Rega which have been classified to have had a diving accident from 2005 to 2014. Patient and diving epidemiology was assessed and the impact of DAN collaboration on patient selection and identification of patients needing transport to HBO facilities were analysed. Results In the 10-year observational period 116 patients with diving accidents were treated by Rega. Mean patient age was 40 (SD 11) years and 95 (82%) were male. If the Rega emergency physician suspected a decompression injury (DCI), without DAN contact 27/28 (96%) of these patients were transported directly to a HBO facility, whereas with DAN contact only 53/63 (84%) needed transport to a HBO facility. DAN was involved in 66/96 (69%) of the cases with suspected DCI on scene, with a significant increase over time (p = 0.001). Mean flight time to HBO facilities was significantly longer (28.9, SD 17.7 min.), compared to non-HBO facilities (7.1, SD 3.2 min., p

Background: Even in a landlocked country like Switzerland recreational diving is becoming more and more popular. Smaller lakes in the Alps are located at an altitude of 2500 m above sea level. The incidence of diving accidents among all helicopter emergency service missions and the consecutive medical knowledge about decompression injuries is low. Thus, a collaboration between the Swiss Air-Ambulance (Rega) and the divers alert network (DAN) was initiated to improve patient treatment and identification of decompression injury and necessity of hyperbaric oxygen therapy (HBO). Methods: Retrospective observational study that includes all patients treated by the Rega which have been classified to have had a diving accident from 2005 to 2014. Patient and diving epidemiology was assessed and the impact of DAN collaboration on patient selection and identification of patients needing transport to HBO facilities were analysed. Results: In the 10-year observational period 116 patients with diving accidents were treated by Rega. Mean patient age was 40 (SD 11) years and 95 (82%) were male. If the Rega emergency physician suspected a decompression injury (DCI), without DAN contact 27/28 (96%) of these patients were transported directly to a HBO facility, whereas with DAN contact only 53/63 (84%) needed transport to a HBO facility. DAN was involved in 66/96 (69%) of the cases with suspected DCI on scene, with a significant increase over time (p = 0.001). Mean flight time to HBO facilities was significantly longer (28.9, SD 17.7 min.), compared to non-HBO facilities (7.1, SD 3.2 min., p < 0.001). Due to specialist advice, patients may have been selected who finally did not need a transport to a HBO facility, although DCI was primarily suspected by the emergency physician on the scene. These patients experienced a significantly reduced flight time to the (non-HBO) hospital of 25.6 (SD 6.5) min. (p < 0.001). Discussion: Collaboration of DAN and Rega may allow a safe patient selection and a consecutive reduction of flight time and costs. Due to international collaborations, evacuation to HBO-facilities for acute recompression therapy can be provided by HEMS within less than 30 min all over Switzerland. Conclusions: For diving accidents among HEMS missions, specialist advice by diving medicine specialists (DAN) appears mandatory to accurately identify and transport patients with decompression injury, as exposure of emergency physicians towards diving accidents and the diagnosis of DCI is low. [ABSTRACT FROM AUTHOR]

Background Current in vivo methods cannot distinguish between the roles of vascular and stationary tissular gas bubbles in the mechanisms of decompression sickness (DCS). New method To answer this question, we designed a normobaric–hyperbaric chamber for studying specifically the contribution of stationary tissular gas bubbles in the mechanisms of DCS in individually-superfused tissue samples. For validating our method, we investigated in rat brain slices exposed to 0.4 MPa air absolute pressure whether fast decompression rate – the most important cause of cerebral DCS – may induce an increase of lactate dehydrogenase (LDH), a marker of cell injury, compared to slow decompression rate. Results We provide a technical description of our pressure chamber and show that fast decompression rate of 0.3 MPa min −1 induced a rapid and sustained increase of LDH release compared to slow compression rate of 0.01 MPa min −1 ( P < 0.0001). Comparison with existing methods There is no current method for studying stationary tissular gas bubbles. Conclusions This report describes the first method for studying specifically in tissue samples the role of stationary tissular gas bubbles in the mechanisms of DCS. Advantageously, according to this method (i) biological markers other than LDH could be easily studied; (ii) tissue samples could be taken not only from the brain but also from any part of the animal's body known of interest in DCS research, allowing performing tissue compartment research, a major question in the physics and theory of decompression research; and (iii) histological studies could be performed from the tissue samples. [ABSTRACT FROM AUTHOR]

Objective: Review the profile of patients with spinal trauma after diving accidents referred to the Puerto Rico Medical Center. This study intended to develop more awareness of the risks of spinal cord injury after diving., Methods: The patient's records for diving accident cases referred to our center during January 2014 until December 2020 were assessed retrospectively. The cases were evaluated according to sex, age, vertebral level, and neurological deficit. The Puerto Rico Medical Center is the only level 1 trauma center in Puerto Rico; therefore, this study likely included all the cases of diving injury on the island., Results: Sixty five patients with a median age of 29 years were identified consisting primarily of males (94%). The regions affected included the cervical (96%), thoracic (2%), and lumbar (2%) spine. Twenty-seven patients (42%) developed a spinal cord injury secondary to a diving accident. Involvement of the C4, C5, or C6 vertebral level, was significant for the development of a spinal cord injury. Diving accidents occurring at beaches were the most common cause., Conclusion: In Puerto Rico, there is a yearly incidence of 9.3 diving accidents causing spinal trauma; these accidents most frequently affect the C6 vertebra. These diving accidents mainly occur in young individuals, predominantly at beaches. Most of our patients were neurologically intact after their diving accident, although 42% sustained a spinal cord injury. This study provided a better understanding of this traumatic event and determined its most affected levels, accident sites, and population involved.

Background: Modern medical technology has promoted the creation and improved the organization of Diving and Hyperbaric Medical Units (DHMU). Objective: This study evaluates patient satisfaction regarding services provided by the DHMU's in Attica, Greece. Material and Method: This is a descriptive study, its sample constitutes of 91 patients admitted at the DHMU of Navy for Hyperbaric Oxygen (HBO) therapy. For the collection of data an anonymous selfadministered, 2-part questionnaire was utilized. The first part consisted of questions recording sociodemographic data, while the second constituted of questions investigating the satisfaction of patients from the DHMU with a five-point Likert scale. The data was analyzed using SPSS (ver 17). Results: A total of 91 patients (53 male, 38 female) with a mean age of 35.5 years, sd=+/-7.245 participated in the study. Most of them 44% were university graduates. Patients' satisfaction from the services provided at DHMU was up to 85.7%, while 87.6% of them highly appreciated the prompt initiating and availability of sessions and rated telephone communication with the DHMU as exceptional. Personnel were described by patients as polite (94.4%), respectful (95.6%) and discrete (94.5%). The 92% of patients understood the importance of abiding by the rules of safety from nurses. Gender, age and the number or treatments were the characteristics that correlated statistically with patients' satisfaction from the services provided at a Greek Diving and Hyperbaric Medical Unit. Conclusion: The patients rated care and access to the particular D.H.M.U. as most excellent. Greek patients experience great satisfaction from the Naval Diving and Hyperbaric Medical Unit. [ABSTRACT FROM AUTHOR]

Cervical spine injuries after diving into private swimming pools can lead to dramatic consequences. We reviewed 34 patients hospitalized in our center between 1996 and 2006. Data was collected from their initial admission and from follow-up appointments. The injuries were sustained by young men in 97% (mean age 27) and the majority happened during the summer (88%). Fractures were at C5–C7 in 70%. American Spinal Injury Association class (ASIA) on admission was A for 8 patients, B for 4, C for 4, D for 1, and E for 17. There were 23 surgical spine stabilizations. Final ASIA class was A for 6 patients, B for 1, C for 3, D for 5, and E for 18. The mean duration of hospitalization was 21.3 days in our neurosurgical center (mean overall cost: 36,000 Euros/patient) plus 10.6 months in rehabilitation center for the 15 patients admitted who had an ASIA class A to C. Mean overall direct cost for a patient with class A is almost 300,000 Euros, compared to around 10,000 Euros for patients with class D and E. In addition, a profound impact on personal and professional life was seen in many cases including 11 divorces and 7 job losses. Dangerous diving into swimming pools can result in spinal injuries with drastic consequences, including permanent physical disability and a profound impact on socio-professional status. Moreover, there are significant financial costs to society. Better prevention strategies should be implemented to reduce the impact of this public health problem. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

STUDY DESIGN::Retrospective study and data analysis. OBJECTIVE::To investigate and analyse the main features of spinal cord injuries due to diving accidents accepted in our Centre from June 1978 to December 2002. SETTING::Regional Spinal Unit of Florence, Italy. INTRODUCTION::Diving accidents mostly occur in a young and healthy population and most of the patients develop tetraplegia with a severe lifelong disability. From 1978 to 2002, 65 patients with spinal injuries due to diving accidents were admitted to the Regional Spinal Unit of Florence. MATERIAL AND METHODS::A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. RESULTS::In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. CONCLUSIONS AND DISCUSSION::Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8?h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.Spinal Cord (2005) 43, 109-116. doi:10.1038/sj.sc.3101695; Published online 23 November 2004 [ABSTRACT FROM AUTHOR]

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Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archiv für Toxikologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries., Material and Methods: We performed a retrospective, descriptive study of patients who have suffered from a traumatic spinal cord injury after a diving accident in the Canary Islands, Spain from 2000 to 2014. These patients were admitted to the Spinal Cord Unit of Hospital Universitario Insular de Gran Canaria., Results: Of the 264 patients admitted to our unit for acute traumatic spinal cord injury, 23 (8.7%) cases were due to diving. Grouping the patients into 5years periods, 56% of the injuries occurred in 2000-2005, 17% in 2006-2010 and 26% in 2011-2014. All patients were male, with a mean age of 29years. Approximately 65% were under 30years. A total of 22/23 patients had a fracture and injury most commonly occurred to the C5 vertebra. Burst fractures were the most common. A total of 86% of cases underwent surgery. All the spinal cord injuries were cervical, with C6 being the neurological level most often affected. A total of 65% of spinal cord injuries were complete injuries., Conclusions: Spinal cord injury secondary to diving accidents is the third leading cause of traumatic spinal cord injury in our setting. It affects young males and the most common clinical presentation is a complete cervical spinal cord injury. Given the irreversible nature of the injury, prevention, aimed mainly at young people, is of great importance., (Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)