The relationship of decongestant use and risk of decompression sickness; a case-control study of Hawaiian scuba divers.

Exposure to cold, dehydration, and aging are known to contribute to the development of decompression sickness (DCS) in divers. Hypertension and nicotine usage have also been suggested as risk factors. Vasoconstriction is an underlying mechanism associated with all of these risk factors. Vasoconstriction increases the degree of bubble formation which is believed to be the cause of DCS. Formed bubbles interfere with the production of nitric oxide which modulates vascular tone resulting in vasoconstriction. Divers commonly use sympathomimetic decongestants which induce vasoconstriction to prevent barotrauma of the ears and sinuses while diving and thus theoretically may contribute to the risk for developing DCS. The purpose of this case-control study was to explore the association between decongestant usage and development of DCS in 400 divers treated/evaluated at the University of Hawai'i, John A. Burns School of Medicine between 1983 and 2010. Bivariate and logistic regression analyses were employed to evaluate differences between cases and controls. In addition to the variable of interest, other co-variables known to have significant influence in the development of DCS were appropriately controlled for during the analyses. In this study population, dehydration (OR = 2.7; 95% CI: 1.1, 7.4), repetitive diving (OR = 2.8; 95% CI: 1.8, 4.4), and violation of dive profiles (OR = 4.9; 95% CI: 3.1, 7.9) contributed independently and significantly to the development of DCS. The co-variables of cold, gender, obesity, and rapid ascents were not significant contributors to developing DCS in this study. There was a small but statistically insignificant risk associated with decongestant use (OR = 1.4; 95% CI: 0.8-2.6; P = .22). The inherent limitations associated with records-based studies may have underestimated this risk. It is important therefore that future research be undertaken to help clarify this concern.

Age associated risks of recreational scuba diving.

The effect of aging on risk for development of decompression illness in divers has often been reported as an incidental finding in epidemiological analyses of diving accidents. No previous publications have specifically attempted to quantify or qualify those risks if present. This study demonstrates that aging increases risk for injury overall, serious injury in particular, and lessens recovery potential.

Hyperbaric oxygen therapy: caveat doctor!

In the right hands, hyperbaric oxygen therapy is a safe and legitimately employed treatment modality for some specific medical conditions. It is not a panacea. It is a prescriptive treatment which should be administered only under the direct supervision of a trained hyperbaric physician. Caveat doctor!

Concomitant cerebral and coronary arterial gas emboli in a sport diver: a case report.

This report presents a case of concomitant cerebral and coronary gas emboli seen in a sport scuba diver after suffering from pulmonary barotrauma. Except for massive fatal gas embolism, no case of concomitant cerebral and coronary arterial gas emboli has been reported. The 45 year old male diver rapidly surfaced from a depth of 32 feet of sea water and experienced transient loss of consciousness, chest pain, and hemiparesis. EKG and cardiac enzymes suggested myocardial ischemia. He received three recompression treatments and recovered completely.

Descriptive epidemiological analysis of diving accidents in Hawaii from 1983 to 2001.

The Hyperbaric Treatment Center (HTC) at the University of Hawaii, has evaluated and treated over 1100 divers for dysbaric disease from 1983 to 2001. We describe some epidemiological parameters and compare trends between local residents and tourist divers in this article. Data obtained from this review were analyzed for age, gender, type of injury and resident status. While trends in Hawaii have mirrored national figures, we did determine that there were some significant differences between resident and tourist divers' patterns of injury over this period of time.