Diving and hyperbaric medicine最新文献

{"title":"Contemporary practices of blood glucose management in diabetic patients: a survey of hyperbaric medicine units in Australia and New Zealand.","authors":"Brenda R Laupland, Kevin Laupland, Kenneth Thistlethwaite, Robert Webb","doi":"10.28920/dhm53.3.230-236","DOIUrl":"10.28920/dhm53.3.230-236","url":null,"abstract":"<p><strong>Introduction: </strong>Blood glucose levels may be influenced by hyperbaric oxygen treatment (HBOT). Patients with diabetes mellitus commonly receive HBOT but there is a lack of standardised blood glucose management guidelines. We documented relevant contemporary practices applied for patients with diabetes treated in hyperbaric medicine units.</p><p><strong>Methods: </strong>A survey was administered in 2022 to the directors of all 13 accredited hyperbaric units in Australia and New Zealand to identify policies and practices related to management of patients with diabetes receiving HBOT.</p><p><strong>Results: </strong>Twelve of the 13 units routinely managed patients with diabetes. Three-quarters (9/12) used < 4 mmol·l^-1 as their definition of hypoglycaemia, whereas the other three used < 5, < 3.6, and < 3 mmol·l^-1. Units reported 26% (range 13-66%) of their patients have a diagnosis of diabetes of which 93% are type 2. Ten (83%) units reported specific written protocols for managing blood glucose. Protocols were more likely to be followed by nursing (73%) than medical staff (45%). Ten (83%) units routinely tested blood glucose levels on all patients with diabetes. Preferred pre-treatment values for treatments in both multiplace and monoplace chambers ranged from ≥ 4 to ≥ 8 mmol·l^-1. Seven (58%) units reported continuation of routine testing throughout a treatment course with five (42%) units having criteria-based rules for discontinuing testing for stable patients over multiple treatments. Two-thirds of units were satisfied with their current policy.</p><p><strong>Conclusions: </strong>This survey highlights the burden of diabetes on patients treated with HBOT and identifies considerable variability in practices which may benefit from further study to optimise management of these patients.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"230-236"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective review of the utility of chest X-rays in diving and submarine medical examinations.","authors":"Willem Aj Meintjes, LaDonna R Davids, Charles H van Wijk","doi":"10.28920/dhm53.3.237-242","DOIUrl":"10.28920/dhm53.3.237-242","url":null,"abstract":"<p><strong>Introduction: </strong>Performance of routine Chest X-rays (CXRs) in asymptomatic individuals to assess hyperbaric exposure risk is controversial. The radiation risk may overshadow the low yield in many settings. However, the yield may be higher in certain settings, such as tuberculosis-endemic countries. We evaluated the utility of routine CXR in diving and submarine medical examinations in South Africa.</p><p><strong>Methods: </strong>Records of 2,777 CXRs during 3,568 fitness examinations of 894 divers and submariners spanning 31 years were reviewed to determine the incidence of CXR abnormality. Associated factors were evaluated using odds ratios and a binomial logistic regression model, with a Kaplan-Meier plot to describe the duration of service until first abnormal CXR.</p><p><strong>Results: </strong>An abnormal CXR was reported in 1.1% per person year of service, yielding a cumulative incidence of 6.5% (58/894) of the study participants. Only four individuals had a clinical indication for the CXR in their medical history. A range of potential pathologies were seen, of which 15.5% were declared disqualifying and the rest (84.5%) were treated, or further investigation showed that the person could be declared fit.</p><p><strong>Conclusions: </strong>In South Africa, a routine CXR has a role to play in detecting abnormalities that are incompatible with pressure exposures. The highest number of abnormalities were found during the initial examinations and in individuals with long service records. Only four individuals had a clinical indication for their CXR during the 31-year span of our study. Similar studies should be performed to make recommendations in other countries and settings.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"237-242"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical distally distributed cutis marmorata decompression sickness associated with unconventional use of thermal protection in a diver with persistent foramen ovale.","authors":"Petra Magri Gatt, Emily Diacono, Lyubisa Matity, Kurt Magri","doi":"10.28920/dhm53.3.285-289","DOIUrl":"10.28920/dhm53.3.285-289","url":null,"abstract":"<p><p>Cutis marmorata is a mottled, marbling, livedoid rash caused by vascular inflammation and congestion in cutaneous decompression sickness. It may occur during or after ascent due to the formation of bubbles from dissolved nitrogen accumulated throughout the dive. It is strongly associated with the presence of right to left shunts, particularly persistent (patent) foramen ovale (PFO). We report a case of cutis marmorata decompression sickness of an unusual pattern associated with unconventional use of thermal protection (a 'shorty' wetsuit worn over full suit) by a diver with a PFO. The patient also had neurological manifestations of decompression sickness. The distal lower limb pattern of involvement favours the hypothesis that cutis marmorata in humans is likely to be due to bubbles in the skin itself and/or adjacent tissues rather than cerebrally mediated.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"285-289"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snorkelling and breath-hold diving fatalities in Australian waters, 2014 to 2018.","authors":"John Lippmann","doi":"10.28920/dhm53.3.210-217","DOIUrl":"10.28920/dhm53.3.210-217","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated snorkelling and breath-hold diving deaths in Australia from 2014-2018 and compared these to those from 2001-2013 to identify ongoing problems and assess the effectiveness of countermeasures.</p><p><strong>Methods: </strong>Media reports and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths for 2014-2018, inclusive. Data were extracted from witness and police reports, medical histories, and autopsies. An Excel® database was created and a chain of events analysis conducted. Comparisons were made with the earlier report.</p><p><strong>Results: </strong>Ninety-one fatalities (78 males, 13 females, median age 48 years [range 16-80]) were identified with one third likely doing some breath-hold diving. Fifty-two of 77 with known body mass index were overweight or obese. Approximately two thirds were inexperienced snorkellers and 64 were alone. Fifty-one were tourists. Planning shortcomings, such as solo diving and diving in adverse conditions, as well as pre-existing health conditions and inexperience predisposed to many incidents. Primary drowning was the likely disabling condition in 39% of cases with drowning recorded as the cause of death (COD) in two thirds. Cardiac events were the likely disabling conditions in 31% although recorded as the COD in 21% of cases.</p><p><strong>Conclusions: </strong>Increasing age, obesity and associated cardiac disease have become increasingly prevalent in snorkelling deaths and there is a need for improved health surveillance and risk management. Closer supervision of inexperienced snorkellers is indicated. Apnoeic hypoxia from extended breath-holding and poor supervision remain a problem. The increased risk of harvesting seafood in areas frequented by large marine predators needs to be appreciated and managed appropriately.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"210-217"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10751292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon monoxide poisoning: lest we forget.","authors":"Bruce Mathew, Gerard Laden","doi":"10.28920/dhm53.3.292","DOIUrl":"10.28920/dhm53.3.292","url":null,"abstract":"","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"292"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective review of divers treated for inner ear decompression sickness at Fiona Stanley Hospital hyperbaric medicine unit 2014-2020.","authors":"Jeremy S Mason, Peter Buzzacott, Ian C Gawthrope, Neil D Banham","doi":"10.28920/dhm53.3.243-250","DOIUrl":"10.28920/dhm53.3.243-250","url":null,"abstract":"<p><strong>Introduction: </strong>Inner ear decompression sickness (IEDCS) is increasingly recognised in recreational diving, with the inner ear particularly vulnerable to decompression sickness in divers with a right-to-left shunt, such as is possible through a persistent (patent) foramen ovale (PFO). A review of patients treated for IEDCS at Fiona Stanley Hospital Hyperbaric Medicine Unit (FSH HMU) in Western Australia was performed to examine the epidemiology, risk factors for developing this condition, the treatment administered and the outcomes of this patient population.</p><p><strong>Methods: </strong>A retrospective review of all divers treated for IEDCS from the opening of the FSH HMU on 17 November 2014 to 31 December 2020 was performed. Patients were included if presenting with vestibular or cochlear dysfunction within 24 hours of surfacing from a dive, and excluded if demonstrating features of inner ear barotrauma.</p><p><strong>Results: </strong>There were a total of 23 IEDCS patients and 24 cases of IEDCS included for analysis, with 88% experiencing vestibular manifestations and 38% cochlear. Median dive time was 40 minutes and median maximum depth was 24.5 metres. The median time from surfacing to hyperbaric oxygen treatment (HBOT) was 22 hours. Vestibulocochlear symptoms fully resolved in 67% and complete symptom recovery was achieved in 58%. A PFO was found in 6 of 10 patients who subsequently underwent investigation with bubble contrast echocardiography upon follow-up.</p><p><strong>Conclusions: </strong>IEDCS occurred predominantly after non-technical repetitive air dives and ongoing symptoms and signs were often observed after HBOT. Appropriate follow-up is required given the high prevalence of PFO in these patients.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"243-250"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Metelkina and Barbaud.","authors":"Oscar Plogmark, Carl Hjelte, Magnus Ekström, Oskar Frånberg","doi":"10.28920/dhm53.3.291","DOIUrl":"10.28920/dhm53.3.291","url":null,"abstract":"","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"291"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Plogmark, et al. Agreement between ultrasonic bubble grades using a handheld self-positioning Doppler product and 2D cardiac ultrasound.","authors":"Asya Metelkina, Axel Barbaud","doi":"10.28920/dhm53.3.290-291","DOIUrl":"10.28920/dhm53.3.290-291","url":null,"abstract":"","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"290-291"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selecting optimal air diving gradient factors for Belgian military divers: more conservative settings are not necessarily safer.","authors":"Sven De Ridder, Nathalie Pattyn, Xavier Neyt, Peter Germonpré","doi":"10.28920/dhm53.3.251-258","DOIUrl":"10.28920/dhm53.3.251-258","url":null,"abstract":"<p><strong>Introduction: </strong>In 2018, the Belgian Defence introduced a commercial off-the-shelf dive computer (Shearwater Perdix™) for use by its military divers. There were operational constraints when using its default gradient factors (GF). We aimed to provide guidelines for optimal GF selection.</p><p><strong>Methods: </strong>The Defence and Civil Institute of Environmental Medicine (DCIEM) dive tables and the United States Navy (USN) air decompression tables are considered acceptably safe by the Belgian Navy Diving Unit. The decompression model used in the Shearwater Perdix (Bühlmann ZH-L16C algorithm with GF) was programmed in Python. Using a sequential search of the parameter space, the GF settings were optimised to produce decompression schedules as close as possible to those prescribed by the USN and DCIEM tables.</p><p><strong>Results: </strong>All reference profiles are approached when GF_LO is kept equal to 100 and only GF_HI is reduced to a minimum of 75 to prolong shallower stop times. Using the Perdix default settings (GF_LO = 30 and GF_HI = 70) yields deeper initial stops, leading to increased supersaturation of the 'slower' tissues, which potentially leads to an increased DCS risk. However, Perdix software does not currently allow for the selection of our calculated optimal settings (by convention GF_LO < GF_HI). A sub-optimal solution would be a symmetrical GF setting between 75/75 and 95/95.</p><p><strong>Conclusions: </strong>For non-repetitive air dives, the optimal GF setting is GF_LO 100, with only the GF_HI parameter lowered to increase safety. No evidence was found that using the default GF setting (30/70) would lead to a safer decompression for air dives as deep as 60 metres of seawater; rather the opposite. Belgian Navy divers have been advised against using the default GF settings of the Shearwater Perdix dive computer and instead adopt symmetrical GF settings which is currently the optimal achievable approach considering the software constraints.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"251-258"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of hyperbaric oxygen treatment for central and branch retinal artery occlusion at a major Australian referral hospital.","authors":"Jeremy Williamson, Anil Sharma, Alexander Murray-Douglass, Matthew Peters, Lawrence Lee, Robert Webb, Kenneth Thistlethwaite, Thomas P Moloney","doi":"10.28920/dhm53.3.224-229","DOIUrl":"10.28920/dhm53.3.224-229","url":null,"abstract":"<p><strong>Introduction: </strong>This study analysed the treatment outcomes of patients that received hyperbaric oxygen treatment (HBOT) for retinal artery occlusion (RAO) at the Royal Brisbane and Women's Hospital in Brisbane, Australia between 2015 and 2021.</p><p><strong>Methods: </strong>Retrospective study from patient records including 22 eyes from 22 patients that received HBOT for either central RAO (17 patients) or branch RAO (five patients). Patients received the Royal Brisbane and Women's Hospital RAO protocol for their HBOT. Analysis included best corrected visual acuity pre- and post-treatment, subjective improvements, side effects and patient risk factors were also recorded.</p><p><strong>Results: </strong>Improvement in best corrected visual acuity was LogMAR -0.2 for central RAO on average with 8/17 (47%) experiencing objective improvement, 5/17 (29%) experienced no change and 4/22 (24%) experienced a reduction in best corrected visual acuity. Subjective improvement (colour perception or visual fields) was reported in an additional 4/17 patients, resulting in 12/17 (71%) reporting improvement either in visual acuity or subjectively. There was no improvement in the best corrected visual acuity of any of the five patients suffering from branch RAO. Cardiovascular risk factors present in the cohort included hypertension, hypercholesterolaemia, previous cardiovascular events, cardiac disease and smoking. Limited side effects were experienced by this patient cohort with no recorded irreversible side effects.</p><p><strong>Conclusions: </strong>Hyperbaric oxygen treatment appears a safe, beneficial treatment for central RAO. No benefit was demonstrated in branch RAO although numbers were small. Increased awareness of HBOT for RAO resulting in streamlined referrals and transfers and greater uptake of this intervention may further improve patient outcomes.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"53 3","pages":"224-229"},"PeriodicalIF":0.8,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10735708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}