Undersea and Hyperbaric Medicine最新文献_第4页

Decompression sickness followed by diabetic ketoacidosis and sepsis shock: an unusual case report. 减压病后继发糖尿病酮症酸中毒和败血症休克：一个不寻常的病例报告。

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2024-01-01

Anwei Liu, Xiaogan Hou, Jing Nie, Qiang Wen, Zhiguo Pan

{"title":"Decompression sickness followed by diabetic ketoacidosis and sepsis shock: an unusual case report.","authors":"Anwei Liu, Xiaogan Hou, Jing Nie, Qiang Wen, Zhiguo Pan","doi":"","DOIUrl":"","url":null,"abstract":"Decompression sickness (DCS) is caused by abrupt changes in extracorporeal pressure with varying severity. Symptoms range from mild musculoskeletal pain to severe organ dysfunction and death, especially among patients with chronic underlying disease. Here, we report an unusual case of a 49-year-old man who experienced DCS after a dive to a depth of 38 meters. The patient's symptoms progressed, starting with mild physical discomfort that progressed to disturbance of consciousness on the second morning. During hospitalization, we identified that in addition to DCS, he had also developed diabetic ketoacidosis, septic shock, and rhabdomyolysis. After carefully balancing the benefits and risks, we decided to provide supportive treatment to sustain vital signs, including ventilation support, sugar-reducing therapy, fluid replacement, and anti-infection medications. We then administered delayed hyperbaric oxygen (HBO2) when his condition was stable. Ultimately, the patient recovered without any sequelae. This is the first case report of a diver suffering from DCS followed by diabetic ketoacidosis and septic shock. We have learned that when DCS and other critical illnesses are highly suspected, it is essential to assess the condition comprehensively and focus on the principal contradiction.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pneumothorax during manned chamber operations: A summary of reported cases. 载人舱手术中的气胸：报告病例摘要

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2024-01-01

Richard E Clarke, Keith Van Meter

{"title":"Pneumothorax during manned chamber operations: A summary of reported cases.","authors":"Richard E Clarke, Keith Van Meter","doi":"","DOIUrl":"","url":null,"abstract":"In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness, and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination of high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent the intrapleural gas volume from expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency, resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations is commonly considered to develop while the patient is under pressure and manifests during ascent. However, published reports suggest that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation, and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA 慢性溃疡患者在 1.4 ATA 和 2 ATA 高压氧仓治疗期间的经皮血氧饱和度值比较

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-12-14 DOI: 10.22462/587

Ram A. Sack, Y. Pikkel, Ortal Leitner-Shemi, Yitzhak Ramon, Yehuda Ullmann, Assaf A. Zeltzer

{"title":"Transcutaneous oximetry values in chronic ulcer patients during Hyperbaric treatment at 1.4 ATA compared to 2 ATA","authors":"Ram A. Sack, Y. Pikkel, Ortal Leitner-Shemi, Yitzhak Ramon, Yehuda Ullmann, Assaf A. Zeltzer","doi":"10.22462/587","DOIUrl":"https://doi.org/10.22462/587","url":null,"abstract":"Chronic wounds have a significant impact on a patient’s quality of life. Different pathologies, such as poor blood supply and tissue breakdown, may lead to inadequate oxygenation of the wound. Hyperbaric oxygen (HBO2) is a widely used treatment for an increasing number of medical practices. A new so-called “hyperbaric treatment” trend has emerged. The use of low-pressure, soft-sided, or inflatable chambers represents a growing trend in hyperbaric medicine. Used in professional settings as well as directly marketed to individuals for home use, they are promoted as equivalent to clinical hyperbaric treatments provided in medical centers. However, these chambers are pressurized to 1.3 atmospheres absolute (ATA) on either air or with an oxygen concentrator, both generate oxygen partial pressures well below those used in approved hyperbaric centers for UHMS-approved indications. A total of 130 consecutive patients with chronic ulcers where tested. TcPO2 was measured near the ulcer area while the patient was breathing 100% O2 at 1.4 ATA for five and 10 minutes. The average TcPO2 at 1.4 ATA after 10 minutes of O2 breathing was 161 mmHg (1-601 mmHg, standard deviation 137.91), compared to 333 mmHg in 2 ATA (1-914±232.56), p < 0.001). Each electrode tested was also statistically significant, both after five minutes of O2 breathing and after 10 minutes. We have not found evidence supporting the claim that 1.4 ATA treatment can benefit a chronic ulcer patient. The field of HBO2 is constantly evolving. We have discovered new ways to treat previously incurable ailments. Nevertheless, it is important to note that new horizons must be examined scientifically, supported by evidence-based data. The actual effect of 1.4 ATA on many ailments is yet to be determined.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139001437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning 脑卒中心电图:继发于急性一氧化碳中毒的脑t波改变

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-28 DOI: 10.22462/630

Xin Xiao, MD, Xiuna Jing, MD, Yun Zhao, MD, Fei Yao, MD, Qing Sun, MD

引用次数: 0

Pneumothorax during manned chamber operations: A summary of reported cases 载人舱室操作期间的气胸:报告病例摘要

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-14 DOI: 10.22462/652

Richard E. Clarke, CHT-A, Keith Van Meter, MD

{"title":"Pneumothorax during manned chamber operations: A summary of reported cases","authors":"Richard E. Clarke, CHT-A, Keith Van Meter, MD","doi":"10.22462/652","DOIUrl":"https://doi.org/10.22462/652","url":null,"abstract":"In-chamber pneumothorax has complicated medically remote professional diving operations, submarine escape training, management of decompression illness and hospital-based provision of hyperbaric oxygen therapy. Attempts to avoid thoracotomy by combination high oxygen partial pressure breathing (the concept of inherent unsaturation) and greatly slowed rates of chamber decompression proved successful on several occasions. When this delicate balance designed to prevent intrapleural gas volume expanding faster than it contracts proved futile, chest drains were inserted. The presence of pneumothorax was misdiagnosed or missed altogether with disturbing frequency resulting in wide-ranging clinical consequences. One patient succumbed before the chamber had been fully decompressed. Another was able to ambulate unaided from the chamber before being diagnosed and managed conventionally. In between these two extremes, patients experienced varying degrees of clinical compromise, from respiratory distress to cardiopulmonary arrest, with successful resuscitation. Pneumothorax associated with manned chamber operations has commonly been considered to develop while the patient was under pressure and manifest during ascent. Published reports suggest, however, that many were pre-existing prior to chamber entry. Risk factors included pulmonary barotrauma-induced cerebral arterial gas embolism, cardiopulmonary resuscitation and medical or surgical procedures usually involving the lung. This latter category is of heightened importance to hyperbaric operations as an iatrogenically induced pneumothorax may take as long as 24 hours to be detected, perhaps long after a patient has been cleared for chamber exposure.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73666939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical and surgical management of pneumothorax in diving and hyperbaric chambers 潜水舱和高压氧舱气胸的内科和外科治疗

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-14 DOI: 10.22462/651

Richard E. Clarke, CHT-A, Keith Van Meter, MD

引用次数: 0

Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review. 高压氧(HBO2)治疗热烧伤的再探讨。压力确实很重要。审查。

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-14 DOI: 10.22462/617

Christian Smolle M.D., Daniel Auinger M.D., Jörg Lindenmann M.D, Josef Smolle M.D., Freyja-Maria Smolle-Juettner M.D., Lars-Peter Kamolz M.D.

{"title":"Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review.","authors":"Christian Smolle M.D., Daniel Auinger M.D., Jörg Lindenmann M.D, Josef Smolle M.D., Freyja-Maria Smolle-Juettner M.D., Lars-Peter Kamolz M.D.","doi":"10.22462/617","DOIUrl":"https://doi.org/10.22462/617","url":null,"abstract":"Throughout more than five decades a multitude of experimental and clinical studies has shown predominantly positive, but also controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. Aim of the study was to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per day, cumulative number of HBO2 sessions and type of chamber were assessed. Out of 47 publications included, 32 were animal trials, four were trials in human volunteers and 11 clinical studies. They contained 94 experiments whose features were processed for statistical evaluation. 64 (67.4%) showed a positive outcome, 16 (17.9%) an ambiguous one and 14 (14.7%) a negative outcome. The only factor independently influencing the results was pressure with ATA (atmospheres absolute) lower than 3 ATA being significantly associated with better outcome (p=0.0005). There is a dire need for well-designed clinical studies in burn centers equipped with hyperbaric facilities to establish dedicated treatment protocols.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76471723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bubble rupture & viability of red blood cells under resonant acoustic standing waves 共振声驻波作用下红细胞的气泡破裂与活力

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-10 DOI: 10.22462/575

Edwin López Ramos, Manuel Rivera Bengoechea, Silvina Cancelos Mancini, Carlos Marín Martín

{"title":"Bubble rupture & viability of red blood cells under resonant acoustic standing waves","authors":"Edwin López Ramos, Manuel Rivera Bengoechea, Silvina Cancelos Mancini, Carlos Marín Martín","doi":"10.22462/575","DOIUrl":"https://doi.org/10.22462/575","url":null,"abstract":"Objective: The presentation of a novel prospective treatment for scenarios where bubble presence in the bloodstream poses a clinical risk. The method relies on generating resonant acoustic standing waves within a limb to non-invasively accelerate dissolution of bubbles present in the bloodstream via bubble rupture. Additionally, a preliminary assessment of the effects of the resonant acoustic waves and bubble rupture events on red blood cell viability is provided. Methods: Two semicircular piezoelectric (PZT) transducers electrically connected to each other were assembled around a small-girth segment of a rear thigh removed from a swine specimen. When driven at the frequency of electric resonance, this swine thigh and PZT transducer arrangement generates resonant acoustic standing waves within the swine thigh. Consequently, mechanical resonance of the system was non-invasively established by monitoring the electric response of the PZT to the applied frequency. The resonant acoustic field generated was used for the detection and rupture of bubbles that travel through a simulated blood vessel installed across the swine thigh. Two sets of experiments were carried out using this methodology, one with the artificial blood vessel filled with saline solution and one with defibrinated sheep blood. For the latter case, a preliminary hematologic assessment was done with red blood cell counts. Conclusion: Resonant acoustic standing waves effectively rupture bubbles of 300µm to 900µm within a simplified swine thigh model. The average dissolved gas content was 44% due to resonant acoustic waves at powers above 20W. No significant effect on red blood cell counts was observed.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89825692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hyperbaric treatment deviations for U.S. Navy divers: Spinal DCS 美国海军潜水员的高压氧治疗偏差:脊柱DCS

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-10 DOI: 10.22462/613

John DeMis MD, Brian Keuski MD, April Due DO

{"title":"Hyperbaric treatment deviations for U.S. Navy divers: Spinal DCS","authors":"John DeMis MD, Brian Keuski MD, April Due DO","doi":"10.22462/613","DOIUrl":"https://doi.org/10.22462/613","url":null,"abstract":"Introduction The United States Navy (USN) developed and refined standardized oxygen treatment tables for diving injuries, but USN tables may not address all situations of spinal decompression sickness (DCS). We describe a detailed recompression treatment regimen that deviated from standard USN protocol for an active-duty USN diver with a severe, delayed presentation of spinal cord DCS. Case Report A USN diver surfaced from his second of three dives on a standard Navy ‘no-Decompression’ Air SCUBA dive (Max depth 101 fsw utilizing a Navy Dive Computer) and developed mid-thoracic back pain, intense nausea, paresthesias of bilateral feet, and penile erection. Either not recognizing the constellation of symptoms as DCS and after resolution of the aforementioned symptoms, he completed the third planned dive (essentially an in-water recompression). Several hours later, he developed paresthesias and numbness of bilateral feet and legs and bowel incontinence. He presented for hyperbaric treatment twenty hours after surfacing from the final dive and was diagnosed with severe spinal DCS. Based on the severity of clinical presentation and delay to treatment, the initial and follow-on treatments were modified from standard USN protocol. MRI of the spine four days after initial presentation demonstrated a 2∙2 cm lesion at the T4 vertebral level extending caudally. Follow-up examinations over two years demonstrated almost complete return of motor and sensory function; however, the patient continued to suffer fecal incontinence and demonstrated an abnormal post-void residual urinary volume. An atypical presenting symptom, a discussion of MRI findings, and clinical correlations to the syndrome of spinal DCS are discussed throughout treatment and long-term recovery of the patient.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87158015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Buoyant ascent rate profiles for the MK10 and MK11 submarine escape and immersion equipment MK10和MK11潜艇逃生和浸入设备的浮力上升率曲线

IF 0.9 4区医学

Undersea and Hyperbaric Medicine Pub Date : 2023-08-09 DOI: 10.22462/631

{"title":"Buoyant ascent rate profiles for the MK10 and MK11 submarine escape and immersion equipment","authors":"","doi":"10.22462/631","DOIUrl":"https://doi.org/10.22462/631","url":null,"abstract":"Introduction: Since the U.S. Navy transitioned from the MK10 to the MK11 submarine escape and immersion equipment (SEIE) there has been an increase in the incident rate of pulmonary barotrauma during submarine escape training. This study compares ascent rate profiles of the MK10 and MK11 SEIE to determine if ascent rate differences between the escape suits are associated with an increase in pulmonary barotraumas. Methods: Buoyant ascent rates of the MK10 and MK11 SEIE were compared using weighted manikins equivalent to the 1st, 50th, and 99th percentile body weight of a submariner. Human ascents using the MK11 (n=126) were compared to human ascents in the same trainer wearing the MK10 (n=124). Results: Manikin mean ascent times were faster for the MK10 compared to the MK11 (5.19 seconds vs 5.28 seconds, p < 0.05). Terminal velocity (Vt) was affected by manikin weight (p < 0.001). Human trials confirmed the manikin results. The average mean ascent velocity for the MK10 group was 0.155 meters/second faster than the MK11 group mean ascent velocity (p < 0.001). Mean ascent velocity was inversely correlated with all anthropometrics for the MK10 group (p < 0.01). Neither height nor body mass index showed a significant association with mean ascent velocity for the MK11 group. Conclusions: The Vt of buoyant ascents are significantly affected by body weight. As the mean ascent rate of the MK11 is slower than that of the MK10, ascent rate profile differences between the suits do not appear to explain the recent increase in pulmonary barotrauma incident rates during escape training.","PeriodicalId":49396,"journal":{"name":"Undersea and Hyperbaric Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86792682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0