ABSTRACT
Medical personnel in hyperbaric treatment centres are at occupational risk for decompression sickness (DCS) while attending patients inside the multiplace hyperbaric chamber (MHC). A 51-year-old male hyperbaric physician, also an experienced diver, was working as an inside attendant during a standard hyperbaric oxygen therapy (HBOT) session (70 minutes at 253.3 kPa [2.5 atmospheres absolute, 15 metres' seawater equivalent]) in a large walk-in MHC. Within 10 minutes after the end of the session, symptoms of spinal DCS occurred. Recompression started within 90 minutes with an infusion of lignocaine and hydration. All neurological symptoms resolved within 10 minutes breathing 100% oxygen at 283.6 kPa (2.8 atmospheres absolute) and a standard US Navy Treatment Table 6 was completed. He returned to regular hyperbaric work after four weeks of avoiding hyperbaric exposures. Transoesophageal echocardiography with a bubble study was performed 18 months after the event without any sign of a persistent (patent) foramen ovale. Any hyperbaric exposure, even within no-decompression limits, is an essential occupational risk for decompression sickness in internal hyperbaric attendants, especially considering the additional risk factors typical for medical personnel (age, dehydration, tiredness, non-optimal physical capabilities and frequent problems with the lower back).
Subject(s)
Decompression Sickness , Hyperbaric Oxygenation , Decompression , Decompression Sickness/therapy , Humans , Male , Middle Aged , Oxygen , Reference Standards , Spinal CordABSTRACT
A serious diving accident can occur in recreational diving even in countries where diving is not very popular due to the fact that diving conditions there are not as great as in some tropical diving locations. The estimated number of injured divers who need recompression treatment in European hyperbaric facilities varies between 10 and 100 per year depending on the number of divers in the population, number of dives performed annually, and number of hyperbaric centres in the country. In 5 years of retrospective observation in Poland (2003-2007) there were 51 cases of injured recreational divers recorded. They either dived locally or after returning home by air from a tropical diving resort. All of them were treated with recompression treatment in the National Centre for Hyperbaric Medicine in Gdynia which has capability to treat any patient with decompression illness using all currently available recompression schedules with any breathing mixtures including oxygen, nitrox, heliox or trimix. The time interval between surfacing and first occurrence of symptoms was significantly lower in the group of patients with neurological decompression sickness or arterial gas embolism (median 0.2 hours) than in the group of patients with other types of decompression sickness (median 2.0 hours). In both groups, there were different types of recompression tables used for initial treatment and different number of additional sessions of hyperbaric oxygenation (HBO) prescribed, but the final outcome was similar. Complete resolution of symptoms after initial recompression treatment was observed in 24 cases, and this number was increased to 37 cases after additional HBO sessions (from 1 to 20). In the final outcome, some residual symptoms were observed in 12 cases. In 2 cases initial diagnosis of decompression sickness type I was rejected after initial recompression treatment and careful re-evaluation of diving profiles, risk factors and reported symptoms.
Subject(s)
Decompression Sickness/diagnosis , Decompression Sickness/therapy , Diving/injuries , Oxygen Inhalation Therapy/methods , Travel , Academic Medical Centers , Adult , Embolism, Air/diagnosis , Embolism, Air/therapy , Humans , Middle Aged , Poland , Pulmonary Edema/diagnosis , Pulmonary Edema/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Direct spectrophotometry has been recognized as a standard reference method in the treatment of victims of carbon monoxide (CO) poisoning. Recently, Masimo (USA) has developed a pulse oximeter for the detection of HbCO. Using new probes, similar to those used for traditional pulse oximetry, several different light wavelengths enable detection of different haemoglobins. METHODS: We have compared forty-nine capillary blood samples taken from patients admitted to the hyperbaric center with CO poisoning. The samples were analyzed using direct spectrophotometry (HbCO) and compared with the corresponding pulse CO-oximeter (SpCO) readings. The Bland-Altman method was used for statistical analysis. RESULTS: The mean HbCO concentration was 18.1+/-12.7% (range 0.1% to 47.4%) and the mean SpCO concentration, 17.6+/-11.3% (range 1.0% to 46.0%). There was a strong positive correlation between laboratory results and bedside readings (r2=0.88). The mean difference between readings was 0.5+/-4.3% (range -11.0% to +9.0%), and the distribution was uniform over the whole range of measured levels. For detection of HbCO levels higher than 20%, the sensitivity of the pulse-CO-oximeter was 77.8%, PPV 82.4%, specificity 90.3%, and NPV 87.5%. CONCLUSIONS: Our study confirmed the accuracy of pulse CO-oximetry for rapid detection of the presence and concentration of HbCO. Since this method is based on analysis of peripheral blood flow, it is not clear if it could be used in patients with low perfusion, hypothermia or burns.
