Diving Medicine Research Articles

Pulmonary Physiology and Medicine of Diving.

Pulmonary physiology is significantly altered during underwater exposure, as immersion of the body and increased ambient pressure elicit profound effects on both the cardiovascular and respiratory systems. Thoracic blood pooling, increased breathing gas pressures, and variations in gas volumes alongside ambient pressure changes put the heart and lungs under stress. Normal physiologic function and fitness of the cardiovascular and respiratory systems are prerequisites to safely cope with the challenges of the underwater environment when freediving, or diving with underwater breathing apparatus. Few physicians are trained to understand the physiology and medicine of diving and how to recognize or manage diving injuries. This article provides an overview of the physiologic challenges to the respiratory system during diving, with or without breathing apparatus, and outlines possible health risks and hazards unique to the underwater environment. The underlying pathologic mechanisms of dive-related injuries are reviewed, with an emphasis on pulmonary physiology and pathophysiology.

Crossings: Dr. Peter Bennett and Dr. Claes Lundgren

We said farewell and thank you to two giants in dive medicine this year: Dr. Peter Bennett and Dr. Claes Lundgren. They leave the proverbial big shoes for us to fill – and a wealth of good works and fond memories.

Dive Medicine: Current Perspectives and Future Directions.

As SCUBA diving continues to rapidly grow in the United States and worldwide, physicians should have a fundamental working knowledge to provide care for an injured diver. SCUBA divers are faced with many hazards at depths that are normally well compensated for at sea level. Pressure gradients, changes in the partial pressure of inhaled gases and gas solubility can have disastrous effects to the diver if not managed properly. Many safety measures in SCUBA diving are governed by the laws of physics, but some have come under scrutiny. This has prompted increased research concerning in water recompression and flying after diving. This article will give physicians an understanding of the dangers divers encounter and the current treatment recommendations. We will also explore some controversies in diving medicine.

Diving and attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a psychiatric condition that affects attention, concentration, impulse control and awareness. Not only these symptoms, but also the medications used to treat ADHD (psychostimulants) pose a risk to both the diver and his or her buddy. This article presents guidelines for recreational diving in combination with ADHD and psychostimulants. These guidelines are based solely on 'expert' opinion and were adopted at a meeting of the Dutch Association for Diving Medicine in 2017.

Establishment of the International Maritime Health Foundation: the next step in scientific publishing in maritime health.

The Bulletin of the Institute of Maritime and Tropical Medicine (IMTM) was published first time in 1948 as a preliminary publication. Since then it has developed and from 1999 it is known as International Maritime Health (IMH). Initially it was published by the Institute of Maritime and Tropical Medicine (IMTM) in Gdynia. From 2009 it was published by the Polish Society of Maritime, Tropical and Travel Medicine (PSMTTM) in cooperation with the International Maritime Health Association (IMHA) and the Norwegian Centre for Maritime Medicine (NCMM), later the Norwegian Centre for Maritime and Diving Medicine (NCMDM) at the Department of Occupational Medicine, Haukeland University Hospital, Bergen. After a couple of years of planning and discussions on how to take the journal forward, the International Maritime Health Foundation (IMHF) was established under Polish Law, 21st June 2018. This article discusses the process from the very beginning of the journal, until the establishment of the IMHF as well as the foundation's objectives and way forward.

Web Alert

Web Alert

Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations.

Rhinologic and oral maxillofacial complications from scuba diving are common, representing approximately 35% of head and neck pathology related to diving. We performed a systematic and comprehensive literature review on the pathophysiology, diagnosis, and treatment of rhinologic and oral maxillofacial pathology related to diving. This included complications due to sinus barotrauma, barodontalgia, odontocrexis, temporomandibular joint dysfunction, partially dentulous patients, and considerations for patients following major head and neck surgery. Of 113 papers accessed, 32 were included in the final synthesis. We created a succinct summary on each topic that should inform clinical decision making by otolaryngologists, dive medicine specialists and primary care providers when faced with pathology of these anatomic sub-sites.

Environmental Physiology and Diving Medicine.

Man’s experience and exploration of the underwater environment has been recorded from ancient times and today encompasses large sections of the population for sport enjoyment, recreational and commercial purpose, as well as military strategic goals. Knowledge, respect and maintenance of the underwater world is an essential development for our future and the knowledge acquired over the last few dozen years will change rapidly in the near future with plans to establish secure habitats with specific long-term goals of exploration, maintenance and survival. This summary will illustrate briefly the physiological changes induced by immersion, swimming, breath-hold diving and exploring while using special equipment in the water. Cardiac, circulatory and pulmonary vascular adaptation and the pathophysiology of novel syndromes have been demonstrated, which will allow selection of individual characteristics in order to succeed in various environments. Training and treatment for these new microenvironments will be suggested with description of successful pioneers in this field. This is a summary of the physiology and the present status of pathology and therapy for the field.

Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care.

Scuba diving is a popular recreational and professional activity with inherent risks. Complications related to barotrauma and decompression illness can pose significant morbidity to a diver's hearing and balance systems. The majority of dive-related injuries affect the head and neck, particularly the outer, middle and inner ear. Given the high incidence of otologic complications from diving, an evidence-based approach to the diagnosis and treatment of otic pathology is a necessity. We performed a systematic and comprehensive literature review including the pathophysiology, diagnosis, and treatment of otologic pathology related to diving. This included inner, middle, and outer ear anatomic subsites, as well as facial nerve complications, mal de debarquement syndrome, sea sickness and fitness to dive recommendations following otologic surgery. Sixty-two papers on diving and otologic pathology were included in the final analysis. We created a set of succinct evidence-based recommendations on each topic that should inform clinical decisions by otolaryngologists, dive medicine specialists and primary care providers when faced with diving-related patient pathology.

Web Alert

Radiology Masterclass Tutorials: http://radiologymasterclass.co.uk/tutorials/tutorials/ Radiology Masterclass is a UK-based web site where educators will find value in materials on the basics of musculoskeletal X-ray. The site provides excellent free content that can be used to teach learners at the medical student level and below. The most valuable material is the descriptive X-ray overlays that clearly define normal anatomy and pathology. It is worth noting that there are some compatibility issues with certain browsers when viewing the images — it would be worth exploring the tutorials in detail before referring learners to the site. In addition to the free content, visitors to the site also can purchase online assessments (price, £67 to 115 per assessment) accredited by the Royal College of Radiologists, London, UK. Cost: Free and paid content. Soc Doc: http://sock-doc.com/ Soc Doc is a web site founded by holistic provider Stephen Gangemi who holds chiropractic and nutrition degrees along with a certification in kinesiology. The site is a lay resource for athlete self-diagnosis of common sport-related injuries. Emphasis is placed on lower body injuries and nutrition pertaining to the endurance athlete. Media includes articles, podcasts, and videos. Visitors also can sign up for a newsletter, participate in the web site’s forum, and sign up to follow Mr. Gangemi on the social media platform of their choosing. Sports medicine providers will find value in the site as a place to refer patients for information on conservative approaches to sport-related health concerns common to the endurance athlete. Cost: Free. Drug Free Sport: http://www.drugfreesport.com/index.asp This is the home web site of The National Center for Drug Free Sport (NCDFS), an organization offering independent drug-testing program management for institutions and organizations. In addition to drug-testing services, the NCDFS also offers assistance in drug policy development and drug program audits. Visitors can subscribe to the NCDFS’s Resource Exchange Center, a database providing up-to-date information on dietary supplements and banned substances. Free educational information for athletes, coaches, administrators, and providers is available under the “myPlaybook Resources” section. Information on the comprehensive myPlaybook educational programs for high school and college athletes also can be found on the site. Team physicians in the process of establishing or revamping their institution’s drug-testing program will be the providers most interested in what this site has to offer. Cost: Free with several subscription-only services. Scuba Doc: http://scuba-doc.com/ Scuba Doc is a free web site with a wealth of information about dive-related medical issues such as decompression sickness, condition-specific considerations, and dive emergency action plans. The information contained on the site will appeal to a wide audience ranging from the nonmedical diver to the physician specializing in dive medicine. Full citations are provided for the contents. Self-assessment quizzes are available for most topics. Perhaps the only weaknesses of this comprehensive web site are the outdated interface and the fact that it was last updated in 2014. Cost: Free. The Office of Disease Prevention and Health Promotion Physical Activity Guidelines: http://health.gov/paguidelines/ The Office of Disease Prevention and Health Promotion (ODPHP) is a U.S. government office within the Department of Health and Human Services. One of the roles of the ODPHP is to maintain physical activity guidelines, with their most recent comprehensive set published in 2008. In addition to providing easy access to the guidelines, the web site contains reports on physical activity, a list of resources from other governmental organizations such as the U.S. Centers for Disease Control and Prevention and U.S. Department of Agriculture, and a regularly updated blog. The site will appeal most to administrators and public health providers interested in promoting exercise within the populations they care for. Cost: Free.

Impact and Challenges of Marine Medicine to Man and its Environment

Marine Medicine is a science of healing, maintaining and restoring health by prevention and treatment in relation to ocean derivatives. It has an associated corollary field called Dive Medicine. Marine ecosystem is a source of unique natural products which are mainly accumulated in living organism and serves as useful pharmacologically active substances. Marine Sponges, Molluscans, Algae, Corals, Ascidians, Bryozoans and Vertebrates are major sources of biomedical compounds. A few medical derived product such as Cytarabrine (Adenine arabinoside), Vidabrine (Cytosine arabinoside), Prialt and Trabectedin are approved by Food and Drug Administration (FDA); additionally several others are currently in preclinical and clinical pipeline. The main emphasis of marine drug discovery is given in search of cure for deadly disease. Divers are exposed to a number of physiological risks as a result of exposure to deep sea. Application of antihistamine drugs, pharmacotherapy and hyperbaric oxygen therapy are the curative method in the treatment of most disease and injuries in marine environment. The Marine environment is vast but not infinite and as a result there is a need for protection of this resource by conservation. Conservation of the marine environment provides enormous benefits for a sustainable future. Marine medicine has given hope to fight debilitating disease of man such as Osteoporosis, Alzheimer’s disease, auto-immune disease and Cancer. To provide and sustain a high momentum of research in marine medicine, there is a need for advance conservation, increased research, more skilled divers, taxonomist, marine chemist and sufficient financial support to improve the benefits of marine medicine to man.

Bomb - Blast Victim with Traumatic Ischemic Injury Treated with Hyperbaric Oxygen

Acute crush injuries and acute traumatic ischemias are indications for hyperbaric oxygen treatment to maximize perfusion and save damaged tissue. Timely multidisciplinary approach is essential in managing blast injuries. ______________________________________________________________________________ * Head of Department ** Senior House Officer *** Clinical Nurse Specialist Hyperbaric and Diving Medicine Department King Hamad University of Bahrain Kingdom of Bahrain Email: adel.abdulaal@khuh.org.bh

Kevin Fong: medicine at the final frontier

Kevin Fong: medicine at the final frontier

Prevalence of Patent Foramen Ovale in Scuba Divers with Decompression Illness Referred from a Specialist Diving Medicine Clinic

Prevalence of Patent Foramen Ovale in Scuba Divers with Decompression Illness Referred from a Specialist Diving Medicine Clinic

Changes in Lung Function After Compressed Air Diving

Diving using compressed air involves the potential for changing lung function through several mechanisms, including bronchial responsiveness. Of particular interest is the effect self-contained underwater breathing apparatus (SCUBA) may have on airflow limitation following a dive such as a possible result of aerosolization of seawater within the regulator, breathing cold dry gas from the tank, or some other putative mechanisms. This cross-sectional observational study was conducted in the field and investigated the hypothesis that bronchoconstriction may occur during a SCUBA dive in some individuals. Measurements included forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow. Spirometry instrumentation provided immediate feedback regarding test quality. Data were collected from May 2007-May 2009, at which time we calculated the data had an 88% statistical power to detect the clinically significant mean change in FEV1 of 200mls. Post-dive lung function values showed no clinically important impairment (FVC fell by 80 mls on average, 95% confidential interval CI 20mls to 140 mls, t(131)=2.57, p=0.01) and the hypothesis was not supported. Of 209 eligible divers who participated in the study, 63% provided valid spirometry data to ERS/ATS standards for acceptability and reproducibility. This study was conducted in the field as opposed to the more commonly used laboratory setting. Although spirometry is a simple test, the ease of data collection was made more difficult by environmental conditions and variables outside the researchers control. Keywords: Scuba diving, respiratory disease, dive medicine, spirometry, follow-up study, forced vital capacity, Post-dive lung function, Bronchospasm

First aid kits for recreational dive boats, what should they contain?

Well-equipped first-aid kits are necessary but not always provided on recreational dive boats. We aimed to review the types of illness and injury likely to be encountered on such boats and inform a content list for such kits. We conducted a 3-round Delphi study by email using a volunteer panel of 18 experts drawn from diving, dive medicine and nursing. In round 1, panellists shared examples of illnesses and injuries they had come across personally. These scenarios were circulated along with findings from a literature review, including existing recommendations. In rounds 2 and 3, the list of kit for dive boats in different settings was iteratively refined through online discussion and feedback. Passengers and crew on recreational dive boats may encounter a range of medical problems from minor injuries to serious accidents and non-dive-related illnesses. Recommended kit varied depending on context and setting (e.g. distance from land, qualifications and experience of crew). Consensus was quickly reached on key first-aid items but experts' views on emergency medicines differed. The study highlights the diversity of medical problems encountered on recreational dive boats. We offer preliminary guidance on the content of suitable first-aid kits and suggest areas for further research.

Diving and hyperbaric medicine

You'd be hard pressed to find a better site than the NHS Scottish Diving Medicine website (www.sdm.scot.nhs.uk). This excellent easy to navigate site contains comprehensive reviews of most aspects of diving medicine from the gas laws to treatment of decompression illness. The information is well referenced and pitched at a level appropriate for the lay diver or the non-diving physician. Contact information and comprehensive emergency procedures are also detailed for Scottish recompression facilities. If you're interested in “fitness to dive,” look no further than the UK Sport Diving Medical Committee (UKSDMC) website (www.uksdmc.co.uk). This group advises …

The physiology and medicine of diving and compressed air work. By P. B. Bennett and D. H. Elliott. 9½ × 6 in. Pp. 528, with 150 illustrations. 1969. London: Baillière, Tindall and Cassell Ltd. £8

Journal Article The physiology and medicine of diving and compressed air work. By P. B. Bennett and D. H. Elliott. 9½ × 6 in. Pp. 528, with 150 illustrations. 1969. London: Baillière, Tindall and Cassell Ltd. £8 Get access The Physiology and Medicine of Diving and Compressed Air Work. By P B Bennett and D H Elliott. 9½ × 6 in. Pp. 528, with 150 illustrations. 1969. London: Baillière, Tindall and Cassell Ltd. £8. British Journal of Surgery, Volume 56, Issue 8, August 1969, Page 639, https://doi.org/10.1002/bjs.1800560821 Published: 07 December 2005

Bennett and Elliott???s Physiology and Medicine of Diving, 5th Edition

Bennett and Elliott???s Physiology and Medicine of Diving, 5th Edition

Psychological aspects of scuba diving injuries: Suggestions for short-term treatment from a psychodynamic perspective

Dive medicine is described as an area of practice in which psychologists may choose to expand their clinical service and research activities. The author argues that most research studying risk behavior and sports take into account biological, behavioral or cognitive approaches, while ignoring unconscious conflict in risk-taking and injury management. The present paper uses a psychodynamically-oriented, interview-based approach to studying psychological reactions to decompression sickness in three experienced scuba divers. Brief interventions and their outcomes are described.