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Another perspective on ACEP policy on critical issues in carbon monoxide poisoning: Invited commentary

The American College of Emergency Physicians (ACEP) recently published its official policy on the evaluation and management of patients with acute carbon monoxide (CO) poisoning [1], an update of the policy previously published in 2008. Three questions regarding CO poisoning were posed to a 30-person ACEP subcommittee, which employed a comprehensive literature review to attempt to draw conclusions. While this is a major step forward, we feel that their conclusions warrant comment. https://doi.org/10.22462/3.4.2017.1

  03-23-2017

Effect of hyperbaric oxygen therapy on blood pressure in patients undergoing treatment

Introduction: Hyperbaric oxygen (HBO2) therapy is generally safe and well tolerated. However, known side effects do exist. Elevation in the blood pressure of patients undergoing HBO2 therapy is a less defined potential side effect. We sought to better quantify effects of HBO2 on blood pressure (BP) in patients undergoing HBO2. Methods: A retrospective chart review was performed on quality assurance data captured on all patients undergoing HBO2 between March 2012 and October 2015 at a large tertiary referral university hospital hyperbaric center. Results: We identified 155 patients who received 3,147 hyperbaric oxygen treatments. For all treatments there was an overall increase in the ..

  03-23-2017

Incidence of middle ear barotrauma in staged versus linear chamber compression during hyperbaric oxygen therapy: a double blinded, randomized controlled trial

Context: Middle ear barotrauma (MEB) is common during chamber compression in hyperbaric oxygen therapy. However, little evidence exists on an optimal compression protocol to minimize the incidence and severity of MEB. Objective: To compare the incidence of MEB during hyperbaric oxygen therapy using two different chamber compression protocols. Design: Double-blinded, randomized controlled trial. Setting: Hyperbaric Medicine Unit, The Townsville Hospital, Queensland, Australia, September 2012 to December 2014. Patients: 100 participants undergoing their first hyperbaric oxygen therapy session. Intervention: Random assignment to a staged (n=50) or a linear (n=50) compression protocols. Photographs of tympanic membranes were taken pre- and post-treatment and then graded. Middle ear barotrauma ..

  03-23-2017

Metabonomic potential plasma biomarkers in abnormal fast buoyancy ascent escape-induced decompression sickness model and the protective effects of pyrrolidine dithiocarbamic acid

Background: Decompression sickness (DCS) induced by fast buoyancy ascent escape (FBAE) is a special DCS, characterized with cardiopulmonary injuries. Serum metabonomics of this type of DCS has not yet been studied. We proposed a metabonomics approach for assessing serum metabonomics changes and evaluating the preventive effect of pyrrolidine dithiocarbamic acid (PDTC) in FBAE-induced DCS rats. Method: Sixty-five (65) rats were divided into three groups, including the Control, DCS and PDTC groups. After receiving physiological saline or PDTC pretreatment, rats in the DCS and PDTC groups received the same protocol of simulated FBAE. Following this, a metabonomics approach – combined with ..

  03-23-2017

Effects of hyperbaric oxygen on hippocampal neuronal apoptosis in rats with acute carbon monoxide poisoning

Introduction: Acute carbon monoxide (CO) poisoning causes serious health problems such as neuropsychological sequelae. This study aimed to investigate neuronal apoptosis and the effects of hyperbaric oxygen (HBO2) on different regions of the rat hippocampus after CO poisoning.  Methods: 90 mature male Sprague Dawley rats were randomly divided into three groups: the normal control group (NC group), the acute carbon monoxide-poisoned group (CO group) and the hyperbaric oxygen treatment group (HBO2 group). CO exposure included 0, 1, 3, 7, 14 and 21 treatment days, one exposure on the first day, and sacrifice on each of the following days. HBO2 exposure included treatment for 0, 1, 3, 7, 14 ..

  03-23-2017

Hypertension screening of commercial divers from an occupational medicine perspective

Hypertension is one of the most common chronic diseases in the world: in the United States, it affects one-third of the adult population. Most cases are primary hypertension – with no identified cause – and significantly increase risk for cardiovascular disease and stroke. At NASA’s Neutral Buoyancy Laboratory (NBL), there is a cadre of professional divers who provide underwater support during extravehicular activity training (EVAs, commonly referred to as “spacewalks”) for astronauts. The NBL occupational health program requires regular “work-site” physical exams, including blood pressure checks, on at least a weekly basis. Although some blood pressures measured during such regular checks ..

  03-23-2017

Cardiovascular and respiratory effects of the neoprene wetsuit in non-immersed divers

A neoprene wetsuit is widely used to reduce thermal dispersion during diving. Recent observations have pointed out that elastic recoil of the wetsuit might have significant compressive effects, able to affect water and electrolyte homeostasis during both dry and immersed conditions. The aim of this study was to evaluate the possible cardiovascular and respiratory effects of the neoprene wetsuit in dry conditions in a sample of experienced divers. Twenty-four (24) healthy divers were evaluated by Doppler-echocardiography and by spirometry in basal conditions and while wearing a full neoprene wetsuit. During wetsuit conditions, we observed a significant decrease in heart rate (-5%; p<0.05) ..

  03-23-2017

Decompression sickness among diving fishermen in Mexico: observational retrospective analysis of DCS in three sea cucumber fishing seasons

The probabilities of decompression sickness (DCS) among diving fishermen are higher than in any other group of divers. Diving behavior of artisanal fishermen has been directed mainly to target high-value species. The aim of this study was to learn about the occurrence of DCS derived from sea cucumber harvesting in the Yucatán Peninsula, Mexico. We conducted a retrospective chart review of diving fishermen treated at a multiplace hyperbaric chamber in Tizimín, Mexico. In total, 233 recompression therapies were rendered to 166 diving fishermen from 2014 to 2016. The average age was 36.7 ± 9.2 years (range: 20-59 years); 84.3% had ..

  03-23-2017

Can amputation be prevented in diabetic foot? Interdisciplinary approach to diabetic foot: a case report

Diabetic foot ulcers may result in loss of an extremity and may even lead to mortality. The use of comprehensive foot care programs which include early screening and evaluation of problems, foot care education, preventive therapy and referral to specialists has been shown to reduce amputation rates by 49-85.  A 51-year-old woman with Type 2 diabetes under surveillance for nine months was referred from the emergency department. She presented with an entirely inflamed right foot with ulcer covering two-thirds proximal of the foot for 30 days’ duration. There was extensive edema as well as cellulitis extending to the knee, fluctuating abscesses and lymphangitis ..

  03-23-2017

Facial nerve paralysis in a diver: a case report

Facial nerve palsy can occur from inflammatory, infectious, ischemic, neoplastic, traumatic, idiopathic and dysbaric causes. We present a case of right-sided facial paralysis after scuba diving in an otherwise healthy, 37-year-old experienced female diver. She completed several dives breathing nitrox over six days, with no difficulties. Thirty-five (35) hours after the last dive she flew by commercial aircraft home and reported that she felt normal. Within 48 hours she developed right-sided facial paralysis, in the absence of viral prodrome. Thorough evaluation by emergency medicine and neurology ruled out stroke. She sought hyperbaric medicine consultation, and we suspected idiopathic facial nerve ..

  03-23-2017

Elimination of CT-detected gas bubbles derived from decompression illness with abdominal symptoms after a short hyperbaric oxygen treatment in a monoplace chamber: a case report

We report the case of a 54-year-old male compressed- air worker with gas bubbles detected by computed tomography (CT). He had complained of strong abdominal pain 30 minutes after decompression after working at a pressure equivalent to 17 meters of sea water for three hours. The initial CT images revealed gas bubbles in the intrahepatic portal vein, pulmonary artery and bilateral femoral vein. After the first hyperbaric oxygen treatment (HBO2 at 2.5 atmospheres absolute/ATA for 150 minutes), no bubbles were detected on repeat CT examination. The patient still exhibited abdominal distension, mild hypesthesia and slight muscle weakness in the ..

  03-23-2017

Carboxyhemoglobin half-life during hyperbaric oxygen in a patient with lung dysfunction: a case report

Introduction: The carboxyhemoglobin half-life (COHb t1/2) during hyperbaric oxygen (HBO2) is often quoted as 23 minutes, derived from the average of two adult male volunteers breathing HBO2 at 3 atmospheres absolute (ATA). However, the mean COHb t1/2 of 12 male volunteer smokers was 26.3 minutes at 1.58 ATA and in 12 non-intubated carbon monoxide (CO)-poisoned patients treated at 3 ATA, was 43 minutes. Case report: An 81-year old male, poisoned by an improperly ventilated natural gas heater, was intubated for coma, then treated with HBO2. His PaO2/FiO2 = 283 from aspiration. His initial COHb was 34.4%, and 18 minutes before HBO2, 5.9%. ..

  03-23-2017

Cave canem: HBO2 therapy efficacy on Capnocytophaga canimorsus infections: a case series

Background: Dog bites are a frequent injury, but the incidence and type of lesions vary across countries. Although only few patients develop complications, the treatment of advanced injuries has a considerable medical, social and economic impact. A frequently isolated pathogen in dog bite wounds is Capnocytophaga canimorsus, a bacterium that can cause sepsis or meningitis. Hyperbaric oxygen (HBO2) therapy has been shown to be useful in treating anaerobic infections, most likely because it creates an inhospitable environment for the bacterium and enhances the patient’s immune response.  Aim: We present a case series of C. canimorsus infections treated with HBO2 in adjunction to antibiotic ..

  03-23-2017

Review of the DAN Annual Diving Report 2016 edition: A report on 2014 data on diving fatalities, injuries and incidents

The previous DAN Annual Diving Report was the 2012-2015 edition that analyzed data over a four-year period from 2010-2013. Similar to the previous edition, this report is composed of four main sections: Diving Fatalities, Diving Injuries, the Diving Incident Reporting System and Breath-hold Diving Incidents. Each segment presents data and includes summaries and vignettes of pertinent cases to better understand why and how injuries occur. https://doi.org/10.22462/3.4.2017.14

  03-23-2017