2022 March;52(1) 

Diving Hyperb Med. 2022 March 31;52(1):2–6. doi: 10.28920/dhm52.1.2-6. PMID: 35313366.

Effect of enriched oxygen inhalation on lower limb skin temperatures in diabetic and healthy humans: a pilot study

Kwan Leong Au-Yeung1,2, Christopher Selvaraj1, Tajrian Amin3, Lawrence K Ma4, Michael H Bennett1

1 Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia
2 Department of Accident and Emergency Medicine, Queen Elizabeth Hospital, HKSAR
3 Department of Medicine, University of New South Wales, Sydney, Australia
4 Department of Psychology, The Education University of Hong Kong, HKSAR

Corresponding author: Dr Kwan L Au-Yeung, 30 Gascoigne Road, Yau Ma Tei, Kowloon, HKSAR
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Key words
Chronic wounds; Diabetes; Hyperoxia; Skin thermometry; Vasoconstriction

Abstract
(Au-Yeung KL, Selvaraj C, Amin T, Ma LK, Bennett MH. Effect of enriched oxygen inhalation on lower limb skin temperatures in diabetic and healthy humans: a pilot study. Diving and Hyperbaric Medicine. 2022 March 31;52(1):2–6. doi: 10.28920/dhm52.1.2-6. PMID: 35313366.)
Introduction: Measurement of skin temperature with infrared thermometry has been utilised for assessing metabolic activity and may be useful in identifying patients with ulcers suitable for hyperbaric oxygen treatment and monitoring their treatment progress. Since oxygen promotes vasoconstriction in the peripheral circulation, we hypothesised that oxygen administration may lower skin temperature and complicate the interpretation of temperatures obtained. This pilot study investigated the effect of oxygen administration on lower limb skin temperature in healthy subjects and diabetic patients.
Methods: Volunteers were recruited from healthy staff members (n = 10) and from patients with diabetic foot ulcers (n = 10) at our facility. Foot skin surface temperatures were measured by infra-red thermometry while breathing three different concentrations of oxygen (21%, 50% and 100%).
Results: Skin temperature changes were observed with increasing partial pressure of oxygen in both groups. The mean (SD) foot temperatures of diabetic patients and healthy controls at air-breathing baseline were 30.1°C (3.6) versus 29.0°C (3.7) respectively, at FiO2 0.5 were 30.1°C (3.6) versus 28.5°C (4.1) and at FiO2 1.0 were 28.3°C (3.2) versus 29.2°C (4.3). None of these differences between groups were statistically significant.
Conclusions: Data from this small study may indicate a difference in thermal responses between healthy subjects and diabetic patients when inhaling oxygen; however, none of the results were statistically significant. Further investigations on a larger scale are warranted in order to draw firm conclusions.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):7–15. doi: 10.28920/dhm52.1.7-15. PMID: 35313367.

Ceiling-controlled versus staged decompression: comparison between decompression duration and tissue tensions

Sergio A Angelini1, Lorenzo Tonetto1, Michael A Lang2

1 Mares SpA, Salita Bonsen 4, 16035 Rapallo (GE), Italy
2 Department of Emergency Medicine, School of Medicine, University of California, San Diego, California, USA

Corresponding author: Dr Sergio Angelini, Mares SpA, Salita Bonsen 4, 16035 Rapallo (GE), Italy
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Key words
Ascent; Computers-diving; Deep diving; Gradient factors; Pressure; Scuba

Abstract
(Angelini SA, Tonetto L, Lang MA. Ceiling-controlled versus staged decompression: comparison between decompression duration and tissue tensions. Diving and Hyperbaric Medicine. 2022 March 31;52(1):7–15. doi: 10.28920/dhm52.1.7-15. PMID: 35313367.)
Introduction: In dissolved gas decompression algorithms, the ceiling is the depth at which the dissolved gas pressure in at least one tissue equals the maximum tolerated value defined by the algorithm. Staged decompression prescribes stationary stops in three-metre intervals so as to never exceed this maximum tolerated value. This keeps the diver deeper than the ceiling until the ceiling itself decreases to coincide with the next, three-metre shallower stage. Ceiling-controlled decompression follows the ceiling in a continuous ascent.
Methods: Mathematical simulations using the ZH-L16C decompression algorithm and gradient factors were carried out for several dive profiles to compare patterns of tissue gas supersaturation and overall decompression times for decompressions based on these approaches.
Results: During a stationary staged decompression stop the available pressure gradient for inert gas washout diminished as inert gas is washed out while inhaled inert gas partial pressure remained unchanged. Ceiling-controlled decompression, on the other hand, maintained the available pressure gradient for inert gas washout at its maximum tolerated level. Decompressions were 4−12% shorter using ceiling-controlled approaches but at the cost of exposing tissues with faster half times to higher levels of supersaturation than they would experience during staged decompression.
Conclusions: Ceiling controlled approaches accelerate decompression but the effect of this on the risk of decompression sickness is unknown.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):16–21. doi: 10.28920/dhm52.1.16-21. PMID: 35313368.

Health and wellbeing of recently active United States scuba divers

Peter Buzzacott1, Charles Edelson2, James Chimiak3, Frauke Tillmans3

1 Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
2 Department of Physics at Indiana University Bloomington, Indiana, USA
3 Divers Alert Network, Durham, North Carolina, USA

Corresponding author: Dr Peter Buzzacott, Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
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Key words
Demography; Diving; Medical conditions and problems; Population; Surveillance

Abstract
(Buzzacott P, Edelson C, Chimiak J, Tillmans F. Health and wellbeing of recently active United States scuba divers. Diving and Hyperbaric Medicine. 2022 March 31;52(1):16–21. doi: 10.28920/dhm52.1.16-21. PMID: 35313368.)
Introduction: This study aimed to describe recently active adult scuba divers in the United States (US) and compare their characteristics with other active adults. The research question was: do active scuba divers have different health and wellbeing characteristics, compared with adults active in other pursuits?
Methods: The Behavioural Risk Factor Surveillance System (BRFSS) is a proportionally representative annual survey of adults in the US. It is the largest continuous population health survey in the world. Since 2011, data on scuba diving is collected biannually. A comparison group were matched on age, sex, being physically active and state of residence.
Results: The dataset comprised 103,686,087 person-years of monthly behavioural data, including 14,360 person years of monthly scuba data. The median weekly frequency of recent scuba diving was 1.0 times per week and the median weekly duration was equivalent to two dives each of one hour. Compared with the comparison group, divers more often earned
> USD$50,000 per year, were less frequently married, with fewer children in the house, which they more often owned. They reported being able to afford a doctor if needed within the previous year, but more often reported excellent/good health and excellent/good mental health, despite the divers being 16% more frequently overweight.
Conclusions: The results demonstrate a relatively healthy cohort of active scuba divers, confirming previous survey results that active divers are commonly college-educated, unmarried, without children, home owning, often overweight, they often currently drink alcohol, and smoked tobacco in the past, but commonly gave up smoking ten years or more ago.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):22–26. doi: 10.28920/dhm52.1.22-26. PMID: 35313369.

Aural health awareness and incident prevention in UK scuba divers

Marguerite St Leger Dowse1, Matthew K Waterman2, Rhodri Jones3, Gary R Smerdon1

1 DDRC Healthcare, Plymouth, UK
2 Wembury Surgery, Wembury, Plymouth, UK
3 Princess of Wales Hospital, Bridgend, UK

Corresponding author: Marguerite St Leger Dowse, DDRC Healthcare, Hyperbaric Medical Centre, Plymouth Science Park, Research Way, Plymouth PL6 8BU, Devon, United Kingdom
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Key words
Decompression sickness; ENT; ETDQ-7; Eustachian tube; Inner ear; Middle ear

Abstract
(St Leger Dowse M, Waterman MK, Jones R, Smerdon GR. Aural health awareness and incident prevention in UK scuba divers. Diving and Hyperbaric Medicine. 2022 March 31;52(1):22–26. doi: 10.28920/dhm52.1.22-26. PMID: 35313369.)
Introduction: Otological disorders, including Eustachian tube dysfunction (ETD), are commonly observed in divers. Data were gathered to observe the prevalence of ear disorders, and awareness of ear health recommendations for recreational divers in the United Kingdom.
Methods: An anonymous online survey included: diver/diving demographics, the validated Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) (a mean score of ≥ 2.1 indicating the presence of dysfunction), pre-existing ear health conditions, medications, decongestants and knowledge of diving and ear health guidance.
Results: A total of 790 divers (64% males) responded (age range 16–80, median 47 years). An ETDQ-7 mean score of ≥ 2.1 was calculated in 315 of 790 respondents (40%), indicating varying degrees of ETD; 56/315 (18%) recorded a pre-existing ear condition. Ear disorders, (external, middle, and inner ear issues) since learning to dive were recorded by 628/790 (79%) of respondents; 291/628 (46%) did not seek medical advice. ETDQ-7 scores of ≥ 2.1 to 6.6 were reported by 293/628 (47%). Six reported inner ear decompression sickness. Decongestants were used by 183/790 (23%). Two hundred and seventy-seven of 790 divers (35%) had aborted a dive with ear problems. Only 214/790 (27%) of respondents were aware of the United Kingdom Diving Medical Committee guidance regarding ear health and diving.
Conclusions: Ear problems and ETD since diving were widely reported in this cohort of divers, with not all divers in this study aware of ear health recommendations and advice.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):27–34. doi: 10.28920/dhm52.1.27-34. PMID: 35313370.

Hyperbaric oxygen treatment for refractory haemorrhagic cystitis occurring after chemotherapy and haematopoietic stem cell transplantation: retrospective analysis of 25 patients

Handan Ozturk1, Bengusu Mirasoglu2, Samil Aktas2

1 Ankara Numune Research and Training Hospital, Underwater and Hyperbaric Medicine Department, Ankara, Turkey
2 Istanbul University, Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul, Turkey

Corresponding author: Associate Professor Bengusu Mirasoglu, Istanbul Tip Fakultesi, Sualti Hekimligi ve Hiperbarik Tip Anabilim Dali, 34093 Fatih, Istanbul, Turkey
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Key words
Cyclophosphamide; Hematopoietic stem cell transplantation; Hemorrhagic cystitis; Hyperbaric research

Abstract
(Ozturk H, Mirosoglu B, Aktas S. Hyperbaric oxygen treatment for refractory haemorrhagic cystitis occurring after chemotherapy and haematopoietic stem cell transplantation: retrospective analysis of 25 patients. Diving and Hyperbaric Medicine. 2022 March 31;52(1):27–34. doi: 10.28920/dhm52.1.27-34. PMID: 35313370.)
Introduction: Intractable haemorrhagic cystitis (HC) is a serious complication of chemotherapy (CT) and haematopoietic stem cell transplantation (HSCT). Hyperbaric oxygen treatment (HBOT) is a promising treatment option based on the similarities in injury pattern and observed histological changes with radiation induced HC, which is an approved indication. We present our experience with HBOT in HC occurring after CT and HSCT.
Methods: Medical files of patients who underwent HBOT between the years 2000−2020 for HC that developed after chemotherapy and/or HSCT were reviewed. Demographic data, primary diagnosis, history of HC and details of HBOT were documented. Treatment outcomes were grouped as complete and partial healing, no response and deterioration.
Results: Twenty-five patients underwent a median of 12 HBOT sessions for HC occurring after CT and HSCT. Complete healing was observed in 11 patients whereas haematuria improved in seven patients. HC grades after HBOT were significantly better than referral grades. A significant correlation was shown with the number of HBOT sessions and change in haematuria. Patients who underwent seven or more HBOT sessions benefitted most.
Conclusions: HBOT appears to be a safe and effective treatment for refractory HC following CT and HSCT. Higher quality evidence would be needed to prove efficacy. However, given the difficulty of conducting randomised controlled trials on such a vulnerable and small group of patients with few treatment options, and given the consistency of current observational evidence, HC occurring after CT and HSCT may be considered as an optional or investigational indication for HBOT.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):35–43. doi: 10.28920/dhm52.1.35-43. PMID: 35313371.

Post COVID-19 fitness to dive assessment findings in occupational and recreational divers

Bengusu Mirasoglu1, Gulsen Yetis1, Mustafa Erelel2, Akin Savas Toklu1

1 Istanbul University, Istanbul Faculty of Medicine, Underwater and Hyperbaric Medicine Department, Istanbul, Turkey
2 Istanbul University, Istanbul Faculty of Medicine, Pulmonary Medicine Department, Istanbul, Turkey

Corresponding author: Associate Professor Bengusu Mirasoglu, Istanbul Tip Fakultesi, Sualti Hekimligi ve Hiperbarik Tip Anabilim Dali, 34093 Fatih, Istanbul, Turkey
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Key words
Pulmonary barotrauma; Radiological imaging; SARS-CoV-2; Scuba diving

Abstract
(Mirasoglu B, Yetis G, Erelel M, Toklu AS. Post COVID-19 fitness to dive assessment findings in occupational and recreational divers. Diving and Hyperbaric Medicine. 2022 March 31;52(1):35–43. doi: 10.28920/dhm52.1.35-43. PMID: 35313371.)
Introduction: It is now known that COVID-19 has long term effects that may not correlate with clinical severity of disease. The known pulmonary and cardiovascular changes as well as thrombotic tendency could predispose to diving accidents. We aimed to investigate COVID-19 related changes that may cause disqualification from diving among divers who recovered from the disease.
Methods: Occupational and recreational divers who applied for fitness to dive (FTD) assessment after COVID-19 infection were included. Routine FTD assessments were performed. Details of COVID-19 history were evaluated. Lung computed tomography (CT) scans were advised if not previously performed or if there were COVID-19 related changes in previous scans. Divers with pathological findings were restrained from diving and followed prospectively.
Results: Forty-three divers were analysed. Thirteen divers were restrained from diving, all due to persistent COVID-19 related changes in lung CT. The prevalence of CT with at least one lung lesion was 68.2% at the time of diagnosis, 73.3% in the first three months after diagnosis and 19.2% later. The most common CT findings were glass ground opacities and fibrotic changes. Demographic characteristics and COVID-19 history of divers deemed ‘unfit’ were similar to those deemed ‘fit’.
Conclusions: Divers who recover from COVID-19 should undergo FTD assessments before resuming diving. A chest CT performed at least three months after diagnosis may be suggested.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):44–48. doi: 10.28920/dhm52.1.44-48. PMID: 35313372.

A Delphi study to identify relevant scenarios as the first step toward an international hyperbaric medicine simulation curriculum

Sylvain Boet1,2,3,4,5,6, Joseph K Burns1,4, Eric Jenisset7,8, Mélanie Papp1, Sylvie Bourbonnais1, Rodrigue Pignel7

1 Department of Anesthesiology and Pain Medicine, Hyperbaric Medicine Unit, Respiratory Therapy Department, The Ottawa Hospital, Ottawa ON, Canada
2 Department of Innovation in Medical Education, University of Ottawa, Ottawa ON, Canada
3 Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa ON, Canada
4 Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa ON, Canada
5 Institut du Savoir Montfort, Ottawa ON, Canada
6 Faculty of Education, University of Ottawa, Ottawa ON, Canada
7 Unité de Médecine Subaquatique et Hyperbare, Hôpitaux Universitaires de Genève, Geneva, Switzerland
8 Direction des Ressources Humaines, Hôpitaux Universitaires de Genève, Geneva, Switzerland

Corresponding author: Dr Sylvain Boet, Department of Anesthesiology and Pain Medicine and Department of Innovation in Medical Education, The Ottawa Hospital, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, Canada, K1H 8L6
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Key words
Education; Hyperbaric oxygen; Safety; Training

Abstract
(Boet S, Burns JK, Jenisset E, Papp M, Bourbonnais S, Pignel R. A Delphi study to identify relevant scenarios as the first step toward an international hyperbaric medicine simulation curriculum. Diving and Hyperbaric Medicine. 2022 March 31;52(1):44–48. doi: 10.28920/dhm52.1.44-48. PMID: 35313372.)
Introduction: Evidence across healthcare specialties suggests that simulation-based education improves practices and patient outcomes. However, simulation has yet to be widely used in hyperbaric medicine education. We aimed to identify the most relevant clinical scenarios for inclusion in a simulation-based curriculum for hyperbaric medicine.
Methods: After ethics approval, we used a modified Delphi consensus method. We assembled an initial questionnaire and distributed it online in English and French to an international group of hyperbaric physicians and operators using a snowball recruitment technique. Participants rated the list of scenarios using a 5-point scale ranging from 1 (least relevant) to 5 (most relevant). Scenarios judged by at least 80% of participants to be relevant (score 4 or 5) were automatically included. Scenarios that did not meet this threshold and new scenarios suggested by participants during the first round were included in a second round.
Results: Seventy-one participants from nine countries, including both physicians and non-physicians, completed the first round and 34 completed the second. Five scenarios were identified as relevant: seizure, fire, cardiac arrest, pneumothorax, and technical deficiency such as power loss while operating the chamber.
Conclusions: Five scenarios relevant for inclusion in the simulation-based curriculum in hyperbaric medicine were identified by expert consensus.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Short communication


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):49–53. doi: 10.28920/dhm52.1.49-53. PMID: 35313373.

Is more complex safer in the case of bail-out rebreathers for extended range cave diving?

Derek B Covington1,2, Charlotte Sadler3,4, Anthony Bielawski3,4, Gareth Lock5, Andrew Pitkin6

1 Department of Anesthesiology, Duke University, Durham (NC), USA
2 Center for Hyperbaric Medicine and Environmental Physiology, Duke University, Durham (NC), USA
3 Division of Undersea and Hyperbaric Medicine, University of California San Diego, San Diego (CA), USA
4 Department of Emergency Medicine, University of California San Diego, San Diego (CA), USA
5 The Human Diver Limited, UK
6 Department of Anesthesiology, University of Florida, Gainesville (FL), USA

Corresponding author: Dr Derek B Covington, Assistant Professor, Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, 2301 Erwin Rd, Durham, NC 27710, USA
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Key words
Deep diving; Diving deaths; Equipment; Risk factors; Risk management; Safety; Technical diving

Abstract

(Covington DB, Sadler C, Bielawski A, Lock G, Pitkin A. Is more complex safer in the case of bail-out rebreathers for extended range cave diving? Diving and Hyperbaric Medicine. 2022 March 31;52(1):49–53. doi: 10.28920/dhm52.1.49-53. PMID: 35313373.)
Nowhere is redundancy more indispensable than extended range cave diving. Training and practice in this discipline ensure divers are equipped with backup regulators, gauges, lights, and adequate breathing gas for a safe exit, emergencies, and decompression. Depending on penetration distances and depth, open circuit cave diving may require carrying more gas cylinders than can be logistically managed by the diver themselves while maintaining safe gas supply margins. Consequently, divers are forced to either stage cylinders in the cave prior to the dive or rely on resupply from support divers. Both scenarios have significant drawbacks. Due to the improved efficiency of breathing gas utilisation and other advantages, closed circuit rebreathers (CCR) have enabled extended range cave diving. With increasing depths, penetration distances, and bottom times, these divers must also plan for an increasing amount of open circuit bail-out gas in the event of CCR failure. Staged cylinders have traditionally been utilised, but this strategy has limitations due to the advanced dives needed to place them and equipment degradation due to prolonged water immersion, which can often result in cylinder and regulator corrosion with consequent leakage of contents over time. Consequently, a growing number of CCR divers are foregoing open-circuit bailout altogether by carrying an additional CCR system for bailout. Although these bailout rebreathers may facilitate further exploration and have certain advantages, the risks of diving with two complex machines remain to be clearly defined.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: The world as it is


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):54–57. doi: 10.28920/dhm52.1.54-57. PMID: 35313374.

Abnormal motor blockade after epidural analgesia caused by pneumorrhachis and the role of hyperbaric oxygen treatment: a case report

Carolina Romano-Ribeiro1, Clara Gaio-Lima2, António P Ferreira2, Belinda Oliveira1, Marta Dias-Vaz1, Óscar Camacho2

1 Anesthesiology Department:  Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
2 Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal

Corresponding author: Dr Óscar Camacho, Unidade de Medicina Hiperbárica, Hospital Pedro Hispano, Matosinhos, Portugal
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Key words
Air; Anaesthesia; Bubbles; Case reports; Hyperbaric Medicine; Pregnancy

Abstract
(Romano-Ribeiro C, Gaio-Lima C, Ferreira AP, Oliveira B, Dias-Vaz M, Camacho O. Abnormal motor blockade after epidural analgesia caused by pneumorrhachis and the role of hyperbaric oxygen treatment: a case report. Diving and Hyperbaric Medicine. 2022 March 31;52(1):54–57. doi: 10.28920/dhm52.1.54-57. PMID: 35313374.)
Introduction: Pneumorrhachis is a rare clinical entity that is usually asymptomatic. Previous reports have associated such events with epidural insertion using a loss of resistance (LOR) to air technique. This report describes a case of symptomatic epidural pneumorrhachis following epidural anaesthesia using LOR to saline.
Case report: A 32-year-old American Society of Anesthesiologists (ASA) Classification II female patient was admitted for unplanned caesarean section. Epidural anaesthesia was performed at the L3-4 space using LOR to saline. The procedure, including delivery of the neonate, was uneventful. In the recovery room, a local anaesthetic infusion via an elastomeric pump (infusion ‘balloon’) was started. Two hours after initiation of the infusion the patient complained of motor blockade, so it was stopped. Two hours later she remained paraparetic, and a neurologist assessment was required. A computed tomography scan showed epidural pneumorrhachis at the L2-3 level. The patient was referred for emergent hyperbaric oxygen treatment (US Navy Treatment Table 5) and following one session the patient recovered completely.
Discussion: Anaesthetists should be aware of this rare complication, which is easily overlooked. Hyperbaric oxygen treatment is a first line treatment for gas-associated lesions with neurological impairment. Timely referral is essential to prevent irreversible deficits.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):58–62. doi: 10.28920/dhm52.1.58-62. PMID: 35313375.

A COVID-19 infection incidentally detected during hyperbaric oxygen treatment and preventive measures for COVID-19 transmission in a multiplace hyperbaric chamber

Abdurrahman E Demir1, Savas Ilbasmis2, Akin S Toklu3

1 University of Health Sciences, Turkey, Department of Aerospace Medicine, Ankara, Turkey
2 Clinic of Hyperbaric Oxygen Therapy, Yunus Emre State Hospital, Eskisehir, Turkey
3 Department of Underwater and Hyperbaric Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

Corresponding author: Abdurrahman E Demir, University of Health Sciences, Department of Aerospace Medicine, General Dr.Tevfik Sağlam Cd, Post Code: 06010, Etlik, Ankara, Turkey. ORCID: 0000-0003-0949-1734.
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Key words
Confined space; Contagion; Infectious diseases; Pressure chambers; SARS-CoV-2

Abstract
(Demir AE, Ilbasmis S, Toklu AS. A COVID-19 infection incidentally detected during hyperbaric oxygen treatment and preventive measures for COVID-19 transmission in a multiplace hyperbaric chamber. Diving and Hyperbaric Medicine. 2022 March 31;52(1):58–62. doi: 10.28920/dhm52.1.58-62. PMID: 35313375.)
Introduction: SARS-CoV-2 (COVID-19) was declared a global pandemic on 11 March 2020 and has become a serious threat to public health. As it can easily be transmitted through droplets and aerosols, there is an increased risk of transmission in enclosed environments such as hyperbaric oxygen treatment (HBOT) units if preventive measures are not taken.
Case report: A 16-year-old female tested positive for SARS-CoV-2 during HBOT for idiopathic sudden sensorineural hearing loss. The other patients and the inside attendant who attended the sessions with her were regarded as contacts, tested for SARS-CoV-2, and quarantined until the test results were available. Ultimately, none of them tested positive.
Discussion: As HBOT in multiplace chambers entails a high risk of SARS-CoV-2 transmission, we strictly adapted our practice to consider that every patient could be a potential asymptomatic carrier. Therefore, the negative results of all contacts in this case and the fact that no confirmed cases of COVID-19 were reported suggests that these measures successfully prevented SARS-CoV-2 transmission in our HBOT clinic. SARS-CoV-2 transmission can be prevented if sufficient protective measures are taken.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):63–65. doi: 10.28920/dhm52.1.63-65. PMID: 35313376.

A diving physician’s experience of dental barotrauma during hyperbaric chamber exposure: case report

Busra Dilara Altun1, Selin Gamze Sümen2, Asim Dumlu1

1 Marmara University, Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul, Turkey
2 Underwater and Hyperbaric Medicine at the University of Health Sciences, Hamidiye Medical Faculty, Istanbul, Turkey

Corresponding author: Dr Busra Dilara Altun, Marmara Üniversitesi Başıbüyük Sağlık Yerleşkesi, Diş Hekimliği Fakültesi, Başıbüyük Yolu 9/3 34854 Başıbüyük, Maltepe, İstanbul, Turkey
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Key words
Barodontalgia; Case reports; Hyperbaric oxygen treatment; Pain

Abstract

(Altun BD, Sümen SG, Dumlu A. A diving physician’s experience of dental barotrauma during hyperbaric chamber exposure: case report. Diving and Hyperbaric Medicine. 2022 March 31;52(1):63–65. doi: 10.28920/dhm52.1.63-65. PMID: 35313376.)
Previous cases of dental barotrauma have been reported in pilots and divers. We report a case of dental barotrauma and barodontalgia in a diving physician accompanying patients during hyperbaric oxygen treatment, and due to pressure changes in the hyperbaric chamber. The physician developed sharp pain localised to the right maxillary molars but radiating to the face, ear and head during decompression from 243 kPa (2.4 atmospheres absolute). The pain intensified following completion of decompression and was consistent with irreversible pulpitis. Clinical examination and panoramic radiography suggested fracture of a heavily restored tooth due to barotrauma. This was managed by tooth extraction. The physician subsequently discontinued accompanying the patients during their hyperbaric oxygen treatment sessions. Dentists and maxillofacial surgery specialists suggest waiting for a minimum of four weeks or until the tooth socket and/or oral tissue has healed sufficiently to minimise the risk of infection or further trauma before exposure to further pressure change. Although seemingly rare, and despite the comparatively slow pressure changes, dental barotrauma can occur in hyperbaric chamber occupants.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case report


2022 March;52(1)

Diving Hyperb Med. 2022 March 31;52(1):66–67. doi: 10.28920/dhm52.1.66-67. PMID: 35313377.

Diving after COVID-19: an update to fitness to dive assessment and medical guidance

Charlotte Sadler1, Miguel Alvarez-Villela2, Karen Van Hoesen1, Ian Grover1, Michael Lang1, Tom Neuman1, Peter Lindholm1

1 Department of Emergency Medicine, School of Medicine, University of California, San Diego, La Jolla (CA), USA
2 Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine, Division of Cardiology, Bronx, New York, USA

Address for correspondence: Dr Charlotte Sadler, Department of Emergency Medicine, School of Medicine, University of California, San Diego, La Jolla (CA), USA
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Key words
Diving medicine; Fitness to dive; Medicals-diving; Occupational health; Pulmonary barotrauma; Recreational diving; Scuba

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Publication Type: Letter to the Editor


 

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