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UHMS Medical Fitness to Work Guidelines for Multiplace Inside Attendants 1st edition

Report of the Hyperbaric Oxygen Safety Committee of the Undersea and Hyperbaric Medical Society This document was written and reviewed by members of the Safety Committee of the UHMS and approved by the UHMS Board of Directors Preface The Board of Directors of the Undersea and Hyperbaric Medical Society (UHMS) acknowledges the work of the authors and the UHMS Safety Committee. It is our hope that this publication will prove helpful to practitioners in the field of hyperbaric medicine. The subject matter in this guide refers to the medical fitness of inside attendants (IAs) to work in a compressed-gas environment. This publication does not ..

  05-07-2018

  05-07-2018

Sensorineural hearing loss after spine surgery treated with hyperbaric oxygen therapy: two case reports

Acute idiopathic sudden sensorineural hearing loss (ISSNHL) following lumbar spinal surgery is an exceedingly rare phenomenon. This paper presents a case of ISSNHL presenting acutely after lumbar spine decompression and fusion treated with transtympanic steroids and hyperbaric oxygen (HBO2) therapy. It also presents the ironic case of SSNHL secondary to presumed viral pathology sustained by the patient’s operative surgeon who was treated with transtympanic steroids and HBO2 as well. Proposed etiologies of the patient’s ISSNHL include: hypo- tension, prone operative position, malfitted/malpositioned headrest, microemboli from a cell-saver, and nitrous oxide anesthesia. The role of systemic hypotension as an etiology of ISSNHL is ..

  05-07-2018

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review

Introduction: CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome. Presentation: We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment. Conclusion: Acute compartment syndrome in the arms after intense ..

  05-07-2018

Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature

Introduction: Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence. Methods: A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included. Results: Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow- up was 36 months, and 63 ± 39% of recurrences occurred during ..

  05-07-2018

Spirometry and oxidative stress after rebreather diving in warm water

Introduction: Hyperbaric oxygen (HBO2) therapy and use of enriched air can result in oxidative injury affecting the brain, lungs and eyes. HBO2 exposure during diving can lead to a decrease in respiratory parameters. However, the possible effects of acute exposure to oxygen-enriched diving on subsequent spiro- metric performance and oxidative state in humans have not been recently described recently. We aim to investigate possible effects of acute (i) hyperbaric and (ii) hyperbaric hyperoxic exposure using scuba or closed-circuit rebreather (CCR) on subsequent spirometry and to assess the role of oxidative state after hyperoxic diving. Methods: Spirometry and urine samples were obtained from six ..

  05-07-2018

A historical review of the U.S. Navy’s busiest recompression chamber in the Pacific theater with a current perspective on caring for civilian divers within its area of responsibility: short communication

On the island Nation of Guam, the United States Department of Defense has stationed military personnel from every service branch. Guam is utilized as a strategic waypoint for the U.S. military in the Pacific theater. As the largest service branch in the region, the Navy has placed a few Diving Medical Officers in Guam to collectively manage and treat patients with recompression therapy. Guam is also a popular tourist destination, with multiple recreational diving companies certifying individuals who are looking to take advantage of the beautiful warm water and exotic marine life. Unfortunately, with an increase in training and ..

  05-07-2018

Heart rate variability changes as an indicator of decompression-related physiological stress

Many aspects of the physiological stress related to the exposure to the hyperbaric environment have been studied, but no research has been made to evaluate the impacts of scuba diving on heart rate variability (HRV). We investigated the effects of a simulated dive to 557 KPa (45 meters of salt water) for a 30-minute bottom time on the frequency and time domains estimators of HRV. Electrocardiogram records were obtained with superficial electrodes for 30 minutes before the simulated dive and, subsequently, for one hour after the dive. Each of these time-series was then subdivided into non-overlapping windows of 256 ..

  05-07-2018

Carboxyhemoglobin: a primer for clinicians

One of carbon monoxide’s several mechanisms of toxicity is binding with circulating hemoglobin to form carboxyhemoglobin, resulting in a functional anemia. While patients with carbon monoxide poisoning are often said to be “cherry-red,” such discoloration is rarely seen. Carboxyhemoglobin levels cannot be measured with conventional pulse oximetry, can be approximated with pulse CO-oximetry, and are most accurately measured with a laboratory CO-oximeter. Carboxyhemoglobin levels are quite stable and can be accurately measured on a transported blood sample. For clinical purposes, arterial and venous carboxyhemoglobin levels can be considered to be equivalent. Carboxyhemoglobin levels are typically lower than 2% in ..

  05-07-2018

Random flap survival with hyperbaric oxygen: daily versus twice-daily treatments

Purpose: Hyperbaric oxygen (HBO2) therapy is used to improve the survival of compromised flaps. Compromised flaps are complications encountered postsurgically, or in traumatic degloving or avulsion injuries. Failed flaps lead to persistence of the defect, requirement of another donor site, and psychosocial sequelae. Although evidence of the benefit of HBO2therapy is significant, there is no consensus on the optimal treatment regimen. The purpose of this study is to examine whether twice-daily treatments (BID HBO2) provide additional benefit compared to daily treatments (QD HBO2) in a rat compromised random flap model. Method: A rat random flap model was used with subjects divided into ..

  05-07-2018

Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial

Background: In prior military randomized trials, participants with persistent symptoms after mild traumatic brain injury (TBI) reported improvement regardless of receiving hyperbaric oxygen (HBO2) or sham intervention. This study’s objectives were to identify outcomes for future efficacy trials and describe changes by intervention. Methods: This Phase II, randomized, double-blind, sham- controlled trial enrolled military personnel with mild TBI and persistent post-concussive symptoms. Participants were ran- domized to receive 40 HBO2 (1.5 atmospheres absolute (ATA), >99% oxygen, 60 minutes) or sham chamber sessions (1.2 ATA, room air, 60 minutes) over 12 weeks. Participants and evalua- tors were blinded to allocation. Outcomes assessed at baseline, ..

  05-07-2018