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Initial management of pulmonary barotrauma in scuba divers
Archives des Maladies Professionnelles et de l’Environnement 2013;74:535-576 practice sports, glycemia, triglyceridemia, total cholesterolemia, HDL and LDL cholesterolemia. The predicted 9-year risk of diabetes is calculated according to the score DESIRE. Datas were analyzed on software EpidataW, by Pearson Chi2 test or by Fisher’s exact test, by analysis of variance test or by Kruskal-Wallis test, and by Spearman correlation coefficient. Results.– The authors propose to give preliminary results for 45 divers seen between 01/01/13 and 01/06/13. Conclusion.– Diabetes is a cons-indication to the exercise of professional diving in France. The interest to assess the prevalence of risk factors and the predictive risk for diabetes is to target prevention. http://dx.doi.org/10.1016/j.admp.2013.07.083 43
Accidents in hyperbaric chambers R. Pougneta,b,c,*, A. Henckesc,e, L. Pougnetc,d, G. Cochardc,e, B. Lodde´a,b,c, D. Lucasc, D. Jegadenc, J.-D. Dewittea,b,c a Universite´ europe´enne de Bretagne, France b Service de sante´ au travail et maladies lie´es a` l’environnement, CHRU Morvan, universite´ de Brest, Brest, France c Socie´te´ franc¸aise de me´decine maritime, 22, avenue CamilleDesmoulins, 29200 Brest, France d Fe´de´ration des laboratoires, HIA Clermont-Tonnerre, Brest, France e Service de me´decine hyperbare, CHRU Cavale Blanche, Brest, France E-mail address: [email protected] Keywords: Diving, Occupational medicine Introduction.– The prevalence of hyperbaric accidents is from 5 to 152 injuries per 100,000 dives for recreational diving. People working in hyperbaric chambers are also subject to these risks. However, few data are available about this. The purpose of the study is to assess the number of accidents in hyperbaric chambers. Materials and methods.– A retrospective study with questionnaire about occupational accidents of hyperbaric chambers staff in France between 2005 and 2010. The data collected were: occupational history, the dive profiles, medical history, and the work accidents occurred (decompression event and decompression illness (DCI), accidental exposure to blood (AEB), physical accident and other accidents). Results.– Twelve (46%) centers participated in the study, 73 subjects in total. The average age was 43.5 years (SD = 9.73). The average seniority was 9.8 years (SD = 7.7). The average number of diving was 198.3 per subject (SD = 174.25), for a total of 8,072 dives. Twenty-seven percent reported having had at least one accident during the study period. There were 30 accidents: 3 AEB, 4 physical accidents, 20 accidents during decompression; 3 other accidents. The hyperbaric accidents were: 2 (10%) decompression sicknesses with cutaneous symptoms; 3 (15%) DCI; 14 (70%) ear traumatisms; 1 (5%) dental accident. So the prevalence of total incidents was 372 for 100,000 dives and, the one of hyperbaric incidents was 248 for 100,000 dives. Conclusion.– The prevalence of incidents and accidents in a hyperbaric chamber seems superior to that of water diving. http://dx.doi.org/10.1016/j.admp.2013.07.084
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Initial management of pulmonary barotrauma in scuba divers 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]
548
Keywords: Diving accidents, Barotrauma, Embolism Introduction.– Pulmonary barotrauma (PB) is a rare emergency. It may be associated with arterial gas embolism requiring hyperbaric oxygen therapy. The purpose of this study was to describe the particularities of PB management in scuba divers. Method.– A retrospective review was carried out to identify cases involving PB in a series of 699 diving accidents referred to the emergency and hyperbaric medicine departments of the Marseille University Hospital Center between 1999 and 2007. Results.– The records of 53 patients were selected for study. Most accidents resulted from poorly controlled decompression when returning to the surface. They occurred mainly in divers who were inexperienced or in training. Various clinical forms of PB were observed. Because plain chest films could be misleading, chest CT-scan was necessary to confirm diagnosis. In half of the cases studied, CT-scan depicted isolated interstitial syndrome. Other findings included pneumothorax in 4 patients and pneumomediastinum in 10. A potential complication of PB was cerebral gas embolism observed in 10 cases and death occurred in 5. Treatment usually consisted in oxygen therapy under normobaric conditions in association with observation and monitoring. Therapeutic recompression was used in 9 cases and pleural drainage was performed in one. Outcome at one month was favorable in all patients except those presenting cerebral arterial gas embolisms who required intensive rehabilitation to limit neurologic sequelae. Conclusion.– If PB is suspected, the emergency care physicians should order CT-scan to rule out arterial gas embolism even in patients without severe symptoms. Patients presenting severe neurological signs should be transferred to the hyperbaric unit immediately. http://dx.doi.org/10.1016/j.admp.2013.07.085 45
Advances in pre-hospital management of diving accidents in the Mediterranean area from 1991 to 2008 M. Coulangea,*, A. Desplantesa, R. Toescaa, C. Castelinb, P. Legrandb, P. Bennerc, B. Barberona, A. Barthe´le´mya, J.-J. Raymondb, J.-P. Auffraya a Department of Emergency Medicine, Critical Care and Hyperbaric Medicine, Marseille, France b Department of Emergency Medicine, Samu 83, Toulon, France c Medical Department of Marseille’s Navy Firefighters, Marseille, France E-mail address: [email protected] Keywords: Diving accidents, Pre-hospital care, Mediterranean area, Medical practice assessment Introduction.– Diving accidents are one of the most common events requiring emergency medical assistance in the maritime setting. Clinical polymorphism, communication problems, and the special features of the marine environment complicate pre-hospital management. The purpose of this study was to evaluate progress in practices after implementation of specific procedures. Methods.– This retrospective study of pre-hospital management of diving accidents was based on a series of 1087 accidents managed by the emergency care and hyperbaric medicine departments of the Marseille University Hospital Center between 1991 and 2008. Results and discussion.– During the study period, alerting emergency coordination services became almost systematic (44% in 1991 versus 87% in 2008) within an increasingly shorter time following the accident. Establishing three-way communications between the person who called in the alert, the maritime rescue coordination center (MRCC), and the physician responsible for coordinating emergency medical care has made it easier to provide optimal pre-hospital care and prompt evacuation. Long-distance medical coordination has not
Accidents in hyperbaric chambers R. Pougneta,b,c,*, A. Henckesc,e, L. Pougnetc,d, G. Cochardc,e, B. Lodde´a,b,c, D. Lucasc, D. Jegadenc, J.-D. Dewittea,b,c a Universite´ europe´enne de Bretagne, France b Service de sante´ au travail et maladies lie´es a` l’environnement, CHRU Morvan, universite´ de Brest, Brest, France c Socie´te´ franc¸aise de me´decine maritime, 22, avenue CamilleDesmoulins, 29200 Brest, France d Fe´de´ration des laboratoires, HIA Clermont-Tonnerre, Brest, France e Service de me´decine hyperbare, CHRU Cavale Blanche, Brest, France E-mail address: [email protected] Keywords: Diving, Occupational medicine Introduction.– The prevalence of hyperbaric accidents is from 5 to 152 injuries per 100,000 dives for recreational diving. People working in hyperbaric chambers are also subject to these risks. However, few data are available about this. The purpose of the study is to assess the number of accidents in hyperbaric chambers. Materials and methods.– A retrospective study with questionnaire about occupational accidents of hyperbaric chambers staff in France between 2005 and 2010. The data collected were: occupational history, the dive profiles, medical history, and the work accidents occurred (decompression event and decompression illness (DCI), accidental exposure to blood (AEB), physical accident and other accidents). Results.– Twelve (46%) centers participated in the study, 73 subjects in total. The average age was 43.5 years (SD = 9.73). The average seniority was 9.8 years (SD = 7.7). The average number of diving was 198.3 per subject (SD = 174.25), for a total of 8,072 dives. Twenty-seven percent reported having had at least one accident during the study period. There were 30 accidents: 3 AEB, 4 physical accidents, 20 accidents during decompression; 3 other accidents. The hyperbaric accidents were: 2 (10%) decompression sicknesses with cutaneous symptoms; 3 (15%) DCI; 14 (70%) ear traumatisms; 1 (5%) dental accident. So the prevalence of total incidents was 372 for 100,000 dives and, the one of hyperbaric incidents was 248 for 100,000 dives. Conclusion.– The prevalence of incidents and accidents in a hyperbaric chamber seems superior to that of water diving. http://dx.doi.org/10.1016/j.admp.2013.07.084
44
Initial management of pulmonary barotrauma in scuba divers 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]
548
Keywords: Diving accidents, Barotrauma, Embolism Introduction.– Pulmonary barotrauma (PB) is a rare emergency. It may be associated with arterial gas embolism requiring hyperbaric oxygen therapy. The purpose of this study was to describe the particularities of PB management in scuba divers. Method.– A retrospective review was carried out to identify cases involving PB in a series of 699 diving accidents referred to the emergency and hyperbaric medicine departments of the Marseille University Hospital Center between 1999 and 2007. Results.– The records of 53 patients were selected for study. Most accidents resulted from poorly controlled decompression when returning to the surface. They occurred mainly in divers who were inexperienced or in training. Various clinical forms of PB were observed. Because plain chest films could be misleading, chest CT-scan was necessary to confirm diagnosis. In half of the cases studied, CT-scan depicted isolated interstitial syndrome. Other findings included pneumothorax in 4 patients and pneumomediastinum in 10. A potential complication of PB was cerebral gas embolism observed in 10 cases and death occurred in 5. Treatment usually consisted in oxygen therapy under normobaric conditions in association with observation and monitoring. Therapeutic recompression was used in 9 cases and pleural drainage was performed in one. Outcome at one month was favorable in all patients except those presenting cerebral arterial gas embolisms who required intensive rehabilitation to limit neurologic sequelae. Conclusion.– If PB is suspected, the emergency care physicians should order CT-scan to rule out arterial gas embolism even in patients without severe symptoms. Patients presenting severe neurological signs should be transferred to the hyperbaric unit immediately. http://dx.doi.org/10.1016/j.admp.2013.07.085 45
Advances in pre-hospital management of diving accidents in the Mediterranean area from 1991 to 2008 M. Coulangea,*, A. Desplantesa, R. Toescaa, C. Castelinb, P. Legrandb, P. Bennerc, B. Barberona, A. Barthe´le´mya, J.-J. Raymondb, J.-P. Auffraya a Department of Emergency Medicine, Critical Care and Hyperbaric Medicine, Marseille, France b Department of Emergency Medicine, Samu 83, Toulon, France c Medical Department of Marseille’s Navy Firefighters, Marseille, France E-mail address: [email protected] Keywords: Diving accidents, Pre-hospital care, Mediterranean area, Medical practice assessment Introduction.– Diving accidents are one of the most common events requiring emergency medical assistance in the maritime setting. Clinical polymorphism, communication problems, and the special features of the marine environment complicate pre-hospital management. The purpose of this study was to evaluate progress in practices after implementation of specific procedures. Methods.– This retrospective study of pre-hospital management of diving accidents was based on a series of 1087 accidents managed by the emergency care and hyperbaric medicine departments of the Marseille University Hospital Center between 1991 and 2008. Results and discussion.– During the study period, alerting emergency coordination services became almost systematic (44% in 1991 versus 87% in 2008) within an increasingly shorter time following the accident. Establishing three-way communications between the person who called in the alert, the maritime rescue coordination center (MRCC), and the physician responsible for coordinating emergency medical care has made it easier to provide optimal pre-hospital care and prompt evacuation. Long-distance medical coordination has not