![]() Although the head-down position is no longer routinely recommended because it can promote cerebral edema, the supine position has advantages over upright posture because it may prevent postural hypotension and enhance inert gas washout. Oxygen not only treats arterial hypoxemia but also enhances the rate of removal of inert gas and the elimination of bubbles. In addition to normal first aid procedures, 100% oxygen (O 2) administration is a priority. The principles of basic and advanced life support apply to any emergency of DCI. Thus, patients affected by DCI must receive adequate treatment promptly. Many patients will later deteriorate, often to a worse condition than their initial symptoms, as a result of progressive tissue damage. The differential diagnosis of DCI includes acute neurological disorders such as stroke and seizure.ĭepending on the amount and location of excess intracorporeal gases, symptoms of DCI may resolve spontaneously in some cases. ![]() Several disorders that DCI may be confused are listed in Table 2. Doppler ultrasonography and echocardiography are useful for research into venous gas emboli, but not for diagnosis of DCI. Audiometry and electronystagmography for audiovestibular DCS can usually be postponed until after recompression. Imaging studies are not recommended for initial assessment because they postpone the time to treatment, except for conditions that require different therapy, such as hemorrhage or pneumothorax. Bubbles are rarely detectable with radiography in joints affected by pain, and are seldom observed in the brain or spine with either MRI or CT. Abnormalities on chest radiographs include pulmonary edema in cardiorespiratory DCS, focal opacities due to aspiration of water or vomitus, and pulmonary overdistension. Thus, complete blood cell count including hemoglobin or packed-cell volume could help guide fluid resuscitation. Severe DCI can be accompanied by hemoconcentration due to damage of the capillary endothelium with capillary leak, and fluid loss from intravascular space. Serum creatine phosphokinase can be elevated in AGE (predominantly the MM and MB isoenzymes), presumably because of myocardial or skeletal muscle injury. Some laboratory abnormalities have been described in DCI, but there are no specific blood markers of the disease. Prevention is best accomplished through the use of a Valsalva maneuver to let air into the middle ears via the Eustachian tubes. Treatment of middle ear barotrauma is generally symptomatic. With TM rupture, pain usually is severe and vertigo can occur from caloric effect if water enters the middle ear. At the other extreme, the TM may tear or rupture. Ultimately the blood vessels become over distended and rupture, bleeding into the TM and the middle ear space. At the same time, reduced air volume in the middle ear is compensated by blood and tissue fluid, causing edema of the middle ear mucosa. If the diver fails to equalize, hydrostatic pressure will force the TM inwards, stretching it and increasing pain. It occurs more commonly during descent and results from failure to actively open the normally closed eustachian tube. It is resulting from inadequate pressure equilibration between the middle ear and the external environment. Middle ear: The most common diving medical problem is middle ear barotrauma, occurring in 30% of first-time divers and 10% of experienced divers.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |