gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Treatment of diving-accidents with oxygen under hyperbaric conditions (HBO)

Meeting Abstract

  • H. Andel - Department of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna
  • D. Andel - Department of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna
  • L. P. Kamolz - Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Landesklinikum Wiener Neustadt, Vienna
  • W. Schramm - Department of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna
  • K. Markstaller - Department of General Anesthesia and Intensive Care, Medical University of Vienna, Vienna

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm019

DOI: 10.3205/11esm019, URN: urn:nbn:de:0183-11esm0193

Published: October 24, 2011

© 2011 Andel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Although diving-accidents may occur during all phases of a dive (descent, isobaric stage, ascent) the main course of accidents is during ascent due to the development of nitrogen bubbles (DCS) or arterial embolization of air (AGE). As DCS and AGE have very similar symptoms, summarized as decompression sickness (DCI). The incidence of non-fatal diving accidents is very low (1/10.000); therefore, they are far from being routine in emergency medicine – especially in “non-diving” countries. Therefore, the main symptoms and treatment will be presented.

Symptoms of DCI: The most common mild symptoms are skin bends, rashes, mottling, itching and lymphatic swelling (DCI I). More severe symptoms include nervous system involvement, pulmonary symptoms and circulatory problems such as hypovolaemic shock (DCI II). Table 1 [Tab. 1], Table 2 [Tab. 2].

Treatment of DCI: Regardless whether the patient suffers from AGE or DCS apart from adequate intravenous hydration, oxygen is the only medication with a proven effect in the treatment of diving accidents. After typical diving accidents, oxygen administration at an inspired concentration (FiO2 1.0) as high as possible is recommended. All patients suspected for DCI should be transferred to a hyperbaric chamber – even if they suffer only from mild symptoms – as DCI I may develop to DCI II within a few hours. Moreover it is important to transfer the buddy of the injured diver as well (as they have performed the same diving profile and may also get symptomatic). Treatment at a hyperbaric chamber follow predefined treatment tables according to the symptoms of the patient (Figure 1 [Fig. 1]).