- Email: [email protected]
Initial management of immersion pulmonary edema
Recueil des re´sume´s should be taken into account with a careful cardiological evaluation (neither cardiopathy nor valvulopathy–controlled blood pressure). Be careful in case of history of first episode. http://dx.doi.org/10.1016/j.admp.2013.07.060 20
Initial management of immersion pulmonary edema M. Coulange*, A. Desplantes, B. Barberon, A. Barthe´le´my, N. Attard, M. Alazia, J.-P. Auffray Department of Emergency Medicine, Critical Care and Hyperbaric Medicine, Marseille, France E-mail address: [email protected] Keywords: Diving, Immersion pulmonary edema, Oxygen therapy Introduction.– During scuba diving, the body is placed under intense physiological constraints that can lead to pulmonary edema in individuals with no history of cardiorespiratory disorders. The purpose of this study was to analyze initial management of these patients with a view to developing a standardized protocol. Methods.– This study presents a mostly female series of 22 divers with a mean age of 49 years referred to the Emergency Department of the Marseille University Hospital Center for pulmonary edema. Most patients had no previous medical history. Results.– Respiratory symptoms including dyspnea, cough, and hemoptysis occurred when returning to the surface after a deep dive lasting more than 30 minutes. In these cases resurfacing often required great physical exertion in a context of hyperoxia, cold, and/or stress. Pulmonary auscultation revealed bilateral crackling sounds that were well tolerated with no sign of right cardiac insufficiency. Mean arterial pressure was stable at 94 mmHg (range, 85 to 105 mmHg) and heart rate at 89 min 1 (range, 60 to 108 min–1). In ambient air, blood oxygen saturation was 92% (range, 82 to 98%) and PaO2 was 70 mm Hg (48 to 90 mm Hg). Diagnosis was assisted by CT scan that showed diffuse interstitial syndrome and ruled out arterial gas effusion. In most cases, treatment consisted of oxygen therapy under normobaric conditions for 24 hours. However, two patients were transferred to the cardiology department due to myocardial ischemia associated with cardiac insufficiency. Outcomes were always favorable and follow-up findings were normal. Conclusion.– Immersion pulmonary edema is characterized by a discrepancy between clinical and laboratory findings. Diagnosis necessitates extensive additional studies and treatment requires oxygen therapy for at least 24 hours. Cardiologic management may be necessary in some cases. http://dx.doi.org/10.1016/j.admp.2013.07.061 21
Medical monitoring onboard diving vessels S. Scott*, D. King Capita Health and Wellbeing, Kent, United Kingdom E-mail address: [email protected] Objective.– To provide the same standard of care equivalent to that available onshore to divers in saturation in a diving support vessel (DSV). Method.– A telemedicine unit (D-MAS) has been developed for use supporting offshore medics within the energy sector. A ‘‘hypersat’’ version of this equipment has been developed and fully tested/ certified for use within a saturation chamber to a depth of 400 m and in an oxygen rich environment. This unit as well as allowing a direct video consultation with a diver in saturation can monitor blood pressure, pulse oximetry and an extended ECG. Attachments for otoscopy, and dermatascopy are also available. This enables the doctor onshore to speak directly to the patient, to observe the patient
or to direct an appropriate physical examination while observing real time vital sign data. This consultation can also be shared via encrypted web conference with other medical specialists as required. The other major benefit of the unit is its small size and that it can be rapidly pressurized when required in saturation. Results.– Testing in the UKCS in DSVs has proved the technology works and can be used to improve the confidence in the diagnosis of medical conditions within saturation and allows onshore medical support to provide a standard of care equivalent to that available onshore. Conclusion.– Real time telemedicine support is practical to provide and significantly improves the degree of support that can be provided remotely to a remote environment. http://dx.doi.org/10.1016/j.admp.2013.07.062
Parallel Session 3 Maritime occupational health 22
Blockading Brest: Scurvy and success in British naval blockades of Brest during the period 1750 to 1820 T. Carter [email protected] Norwegian Centre for Maritime Medicine, University of Bergen, Bergen, Norway Keeping the French Atlantic fleet confined at the naval base of Brest and preventing or at worst detecting any moves to mobilise into open waters was one of the prime objectives of the British Navy during both the Seven Years War of 1756–1763 and the Napoleonic Wars of 1799–1815. Blockade was established during both conflicts. This required a squadron of ships to be stationed off Brest continuously and either re-supplied at sea or replaced regularly by new vessels from bases in Britain. This was an arduous posting with long periods in hostile seas, with no prospect of shelter in the event of storms and where continuous vigilance and readiness to fight against a well organised and armed force were needed. Outbreaks of scurvy were common among the seamen on the blockading ships during the Seven Years War and the early years of the Napoleonic wars but there were changes to provisioning from around 1800. It was then accepted that citrus fruits and fresh meat and vegetables should be supplied not just for those suffering from scurvy but as a preventative measure. This led to a great reduction in the frequency of the disease and greatly increased the British navy’s ability to maintain an effective blockade. I will examine the background to this change in policy and its effectiveness as well as consider why it took so long for it to be established following the work of James Lind in 1747. http://dx.doi.org/10.1016/j.admp.2013.07.063
Plenary Session 4 Emergencies at sea 23
Epidemiology of health evacuations in high sea by helicopter of the French Navy for the benefit of sea fishermen U. Vinsonneaua, C. Cerezb,*, A. Michelb a Service de cardiologie, HIA Clermont-Tonnerre, Brest, France b Base ae´ronavale de Lanveoc-Poulmic, Lanveoc-Poulmic, France E-mail address: [email protected] Keywords: Fishermen, French Army, Search and rescue, High sea, Helicopter
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Initial management of immersion pulmonary edema M. Coulange*, A. Desplantes, B. Barberon, A. Barthe´le´my, N. Attard, M. Alazia, J.-P. Auffray Department of Emergency Medicine, Critical Care and Hyperbaric Medicine, Marseille, France E-mail address: [email protected] Keywords: Diving, Immersion pulmonary edema, Oxygen therapy Introduction.– During scuba diving, the body is placed under intense physiological constraints that can lead to pulmonary edema in individuals with no history of cardiorespiratory disorders. The purpose of this study was to analyze initial management of these patients with a view to developing a standardized protocol. Methods.– This study presents a mostly female series of 22 divers with a mean age of 49 years referred to the Emergency Department of the Marseille University Hospital Center for pulmonary edema. Most patients had no previous medical history. Results.– Respiratory symptoms including dyspnea, cough, and hemoptysis occurred when returning to the surface after a deep dive lasting more than 30 minutes. In these cases resurfacing often required great physical exertion in a context of hyperoxia, cold, and/or stress. Pulmonary auscultation revealed bilateral crackling sounds that were well tolerated with no sign of right cardiac insufficiency. Mean arterial pressure was stable at 94 mmHg (range, 85 to 105 mmHg) and heart rate at 89 min 1 (range, 60 to 108 min–1). In ambient air, blood oxygen saturation was 92% (range, 82 to 98%) and PaO2 was 70 mm Hg (48 to 90 mm Hg). Diagnosis was assisted by CT scan that showed diffuse interstitial syndrome and ruled out arterial gas effusion. In most cases, treatment consisted of oxygen therapy under normobaric conditions for 24 hours. However, two patients were transferred to the cardiology department due to myocardial ischemia associated with cardiac insufficiency. Outcomes were always favorable and follow-up findings were normal. Conclusion.– Immersion pulmonary edema is characterized by a discrepancy between clinical and laboratory findings. Diagnosis necessitates extensive additional studies and treatment requires oxygen therapy for at least 24 hours. Cardiologic management may be necessary in some cases. http://dx.doi.org/10.1016/j.admp.2013.07.061 21
Medical monitoring onboard diving vessels S. Scott*, D. King Capita Health and Wellbeing, Kent, United Kingdom E-mail address: [email protected] Objective.– To provide the same standard of care equivalent to that available onshore to divers in saturation in a diving support vessel (DSV). Method.– A telemedicine unit (D-MAS) has been developed for use supporting offshore medics within the energy sector. A ‘‘hypersat’’ version of this equipment has been developed and fully tested/ certified for use within a saturation chamber to a depth of 400 m and in an oxygen rich environment. This unit as well as allowing a direct video consultation with a diver in saturation can monitor blood pressure, pulse oximetry and an extended ECG. Attachments for otoscopy, and dermatascopy are also available. This enables the doctor onshore to speak directly to the patient, to observe the patient
or to direct an appropriate physical examination while observing real time vital sign data. This consultation can also be shared via encrypted web conference with other medical specialists as required. The other major benefit of the unit is its small size and that it can be rapidly pressurized when required in saturation. Results.– Testing in the UKCS in DSVs has proved the technology works and can be used to improve the confidence in the diagnosis of medical conditions within saturation and allows onshore medical support to provide a standard of care equivalent to that available onshore. Conclusion.– Real time telemedicine support is practical to provide and significantly improves the degree of support that can be provided remotely to a remote environment. http://dx.doi.org/10.1016/j.admp.2013.07.062
Parallel Session 3 Maritime occupational health 22
Blockading Brest: Scurvy and success in British naval blockades of Brest during the period 1750 to 1820 T. Carter [email protected] Norwegian Centre for Maritime Medicine, University of Bergen, Bergen, Norway Keeping the French Atlantic fleet confined at the naval base of Brest and preventing or at worst detecting any moves to mobilise into open waters was one of the prime objectives of the British Navy during both the Seven Years War of 1756–1763 and the Napoleonic Wars of 1799–1815. Blockade was established during both conflicts. This required a squadron of ships to be stationed off Brest continuously and either re-supplied at sea or replaced regularly by new vessels from bases in Britain. This was an arduous posting with long periods in hostile seas, with no prospect of shelter in the event of storms and where continuous vigilance and readiness to fight against a well organised and armed force were needed. Outbreaks of scurvy were common among the seamen on the blockading ships during the Seven Years War and the early years of the Napoleonic wars but there were changes to provisioning from around 1800. It was then accepted that citrus fruits and fresh meat and vegetables should be supplied not just for those suffering from scurvy but as a preventative measure. This led to a great reduction in the frequency of the disease and greatly increased the British navy’s ability to maintain an effective blockade. I will examine the background to this change in policy and its effectiveness as well as consider why it took so long for it to be established following the work of James Lind in 1747. http://dx.doi.org/10.1016/j.admp.2013.07.063
Plenary Session 4 Emergencies at sea 23
Epidemiology of health evacuations in high sea by helicopter of the French Navy for the benefit of sea fishermen U. Vinsonneaua, C. Cerezb,*, A. Michelb a Service de cardiologie, HIA Clermont-Tonnerre, Brest, France b Base ae´ronavale de Lanveoc-Poulmic, Lanveoc-Poulmic, France E-mail address: [email protected] Keywords: Fishermen, French Army, Search and rescue, High sea, Helicopter
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