The Influence of Advanced Hyperbaric Medical Training on Arterial Gas Embolism Treatment.

3d Reconnaissance Battalion, a forward-deployed Marine Corps unit in Okinawa, Japan, frequently performs diving operations. Often throughout the year, several reconnaissance teams are diving simultaneously in different locations for training. We present a case of an otherwise healthy 30-year-old-male Reconnaissance Marine who surfaced from a dive with abnormal symptoms and received prompt care from exercise participants who were nonmedical personnel. Studies have demonstrated improved morbidity outcomes in decompression illness patients with shorter times to hyperbaric treatment following the onset of symptoms. High-risk military exercises with diving components have a mandatory safety structure that includes recompression chamber support. All United States Marine Corps Reconnaissance, Marine Corps Special Operations Command, and U.S. Navy dive operations are required to have at least one diving supervisor. To expand the diving capabilities of the unit, Marines are encouraged to attend training and qualify as diving supervisors. This case study demonstrates the efficacy and importance of training Recon Marines to recognize decompression illness as diving supervisors.

Updates in diving medicine: evidence published in 2017-2018.

This report summarizes some of the most relevant studies during the 2017-2018 academic year of scientific literature for diving medicine. The article selection is the result of a PubMed search for "diving," as well as a manual review of the journals Undersea and Hyperbaric Medicine and Diving and Hyperbaric Medicine. Four articles were published reporting on new advances in decompression modeling. New consensus guidelines in the prehospital treatment of decompression sickness were published as well as a retrospective review of the efficacy of the U.S. Navy Treatment Tables. Several articles were published this year researching cardiovascular health and fitness to dive. A novel approach by one occupational medicine clinic for referral for hypertension may allow for early intervention of the "silent killer." Application of the Framingham risk score to commercial divers does not result in an excessive number of disqualifications. The controversy over screening and subsequent repair of a patent foramen ovale in divers was heavily researched this past year. Several groups reported their experience with closure and associated risks. Subjects diving with pre-existing conditions were surveyed and found to be fairly common, with seemingly little ill effect (albeit with a potential survivor bias). Recommendations for diving while using antidepressants were reported. Several articles were published utilizing point of care ultrasound in the diagnosis of immersion pulmonary edema (IPE). One case of a using sildenafil as a preventative medication in a triathlete with an extensive history of IPE may prove promising for further research. Finally, an extensive review article pertaining to hypercapnia in diving was published as well as the use of pulse oximetry as an early warning system to prevent hypoxia in rebreather divers.