The Physician's Guide to Diving Medicine by C.B. CarlstonThe Physician's Guide to Diving Medicine by C.B. Carlston

The Physician's Guide to Diving Medicine

EditorC.B. Carlston, R.A. Mathias, C.W. Shilling

Paperback | December 10, 2011

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This book is designed to be a physician's guide for those interested in diving and hyperbaric environments. It is not a detailed document for the erudite researcher; rather, it is a source of information for the scuba-diving physician who is searching for answers put to him by his fellow nonmedical divers. Following the publication of The Underwater Handbook: A Guide to Physiology and Performance for the Engineer there were frequent requests for a companion volume for the physician. This book is designed to fill the void. Production of the book has been supported by the Office of Naval Research and by the Bureau of Medicine and Surgery, Research and Development Command, under Navy Contract No. NOOOOI4-78-C-0604. Our heartfelt thanks go to the many authors without whose contributions the book could not have been produced. These articles are signed by the responsible authors, and the names a~e also listed alphabetically in these preliminary pages. Every chapter was officially reviewed by at least one expert in the field covered and these reviewers are also listed on these pages. Our thanks go to them for their valuable assistance. We are grateful to Marthe Beckett Kent for editing Chapter III. Our thanks also go to Mrs. Carolyn Paddon for typing and retyping the manuscripts, and to Mrs. Catherine Coppola, who so expertly handled the many fiscal affairs.
Title:The Physician's Guide to Diving MedicineFormat:PaperbackPublished:December 10, 2011Publisher:Springer USLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:1461296633

ISBN - 13:9781461296638

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Table of Contents

I The Diving Environment.- A. Introduction.- B. Types of Diving.- 1. General.- 2. Breath-Hold Diving.- 3. Scuba Diving.- 4. Surface-Supplied Diving.- 5. Bounce Diving.- 6. Saturation Diving.- 7. Excursion Diving.- C. Natural Diving Environments.- 1. General.- 2. Oceans.- 3. Lakes.- 4. Rivers.- 5. Harbors.- 6. Cave Diving.- 7. Diving in Kelp.- 8. Diving in Polluted Water.- 9. Diving in Wrecks.- 10. Diving in Cold Water.- 11. Diving under Ice.- References.- D. Man-Made Diving Environments.- 1. Introduction.- 2. Caissons and Tunnels.- 3. Deck Decompression Chambers.- 4. Diving Systems.- 5. System Characteristics.- 6. Hyperbaric Facilities.- 7. Rescue Chambers.- 8. Undersea Habitats and Underwater Welding Chambers.- References.- II Physics of Diving and Physical Effects on Divers.- A. Introduction.- B. Pressure.- 1. Units of Pressure.- 2. Pressure Nomenclature.- C. Pathophysiology of Gases Associated With Diving.- 1. Air.- 2. Oxygen.- a. Description.- b. Partial Pressure.- c. Toxicity.- d. Use of High Pressure Oxygen (HBO).- 3. Nitrogen.- a. Description.- b. Physiological Effects.- 4. Helium.- 5. Hydrogen.- 6. Neon.- 7. Carbon Dioxide.- a. Description.- b. Human Production.- c. Control of Breathing.- d. Transport.- e. Symptoms and Signs of Carbon Dioxide Retention.- f. Diving Implications.- g. Causes of Carbon Dioxide Excess.- h. Remedial Measures and Prevention.- 8. Carbon Monoxide.- a. Description.- b. Causes of Carbon Monoxide Poisoning in Diving.- c. Symptoms.- d. Treatment.- D. Gas Laws.- 1. Boyle's Law.- 2. Charles' Law.- 3. General Gas Law.- 4. Dalton's Law.- 5. Henry's Law.- E. Characteristics of Gas.- 1. Diffusion.- 2. Moisture.- 3. Density.- 4. Viscosity.- F. Buoyancy.- G. Energy in Diving.- 1. Light.- 2. Sound.- 3. Heat.- 4. Temperature.- 5. Specific Heat.- 6. Conduction.- 7. Convection.- 8. Radiation, Evaporation.- H. Effects of Changing Pressure on the Diver.- 1. Aural Barotrauma.- 2. Blowup.- 3. Gastrointestinal Barotrauma.- 4. Pulmonary Barotrauma.- 5. Sinus Barotrauma.- 6. Squeeze.- 7. Toothache or Aerodontalgia.- 8. Vertigo.- I. Summary.- References.- III Physiology of Diving.- A. Respiration.- 1. Lung Volumes: Effects of Gas Compression and Expansion.- a. Dynamics of Gas Flow in the Lungs.- 2. Gas Density, Ventilation Distribution, Gas Exchange.- a. Control of Ventilation and Carbon Dioxide Retention.- References.- B. Immersion Effects.- 1. Respiratory Function.- 2. Circulatory Function.- a. Significance.- 3. Renal Effects.- a. Significance.- 4. Gastrointestinal System Effects.- a. Significance.- 5. Buoyancy Effects.- References.- C. Cardiovascular Effects.- 1. Hyperbaric Bradycardia.- a. Early Studies.- b. Effects of Increased Partial Pressure of Oxygen.- c. Effects of Increased Gas Density.- d. Effects of Increased Hydrostatic Pressure.- e. Effects of Increased Gas Tensions of Helium and Nitrogen.- f. Autonomic Mediation of Hyperbaric Bradycardia.- 2. Cardiovascular Effects of Saturation Exposure.- 3. Summary.- References.- D. High Pressure Nervous Syndrome.- 1. Signs and Symptoms in Man.- 2. Strategies for Amelioration of HPNS.- a. Variation in Susceptibility and Personnel Selection.- b. Choice of Compression Rate.- c. Use of Excursions.- d. Adaptation.- e. Use of Narcotic Agents.- References.- E. Inert Gas Narcosis.- 1. Nitrogen Narcosis.- 2. Other Gases and Narcosis.- a. Argon.- b. Xenon.- c. Helium.- d. Neon.- e. Hydrogen.- 3. Quantification of Narcotic Effects.- a. Rapid Compression Effects.- b. Carbon Dioxide Effects.- c. Individual Differences in Narcotic Response.- 4. Mechanisms of Action Underlying Inert Gas Narcosis.- 5. Inert Gas Effects.- a. Model Surface Membrane Effects.- b. Inert Gas Protection against the High Pressure Nervous Syndrome.- c. Opposing Physiological Effects of Pressure and Inert Gases.- d. Clinical Use of Nitrogen Narcosis as a Benign Stress.- References.- F. Women and Diving.- 1. History.- 2. Physical Performance and Adaptability.- 3. Decompression Sickness.- a. Extra Fat Burden.- b. Oral Contraceptives.- c. Intrauterine Devices.- d. Premenstrual Fluid Retention and Menstruation.- e. Summary.- 4. Pregnancy and Diving.- 5. Questions Frequently Asked.- References.- G. Monitoring of Vital Signs; Doppler Monitoring.- 1. Voice Communication.- 2. Cardiovascular Monitors.- 3. Pulmonary Monitoring.- 4. Temperature Monitoring.- 5. Bubble Detection.- a. Ultrasound Research and Methods.- b. Clinical Significance.- References.- H. Thermal Considerations.- 1. Heat Exchanges in Air at One Atmosphere.- 2. Thermal Balance in Water at One Atmosphere Absolute.- a. Heat Transfer Coefficient of Water and Critical Water Temperature.- b. Quantity of Heat Loss.- c. Protection by Wet Suits.- d. Regional Heat Loss.- e. Effects of Exercise.- f. Symptoms of Severe and Prolonged Cold Exposure.- g. Treatment of Immersion Hypothermia.- h. Effects of Alcohol and Marijuana.- i. Cold Acclimatization.- 3. Thermal Balance in Dry Hyperbaric Environments.- a. Heat Transfer Properties.- b. Heat Exchange.- 4. Thermal Balance in Wet Hyperbaric Environments.- References.- I. Metabolism and Dietary Effects.- 1. Energy Metabolism in Divers.- a. Energy Metabolism in the Ama.- b. Energy Metabolism in Saturation Divers.- 2. Electrolyte Metabolism in Divers.- 3. Dietary Effects.- References.- J. Hyperbaric Arthralgia.- References.- K. Vestibular and Auditory Function.- 1. Auditory Function.- 2. Vestibular Function.- References.- L. Vision.- 1. Physical Factors in Underwater Seeing.- a. Vision without a Face Mask.- b. Effects of Refraction.- c. Effects of Absorption and Scatter.- 2. Physiological Factors in Underwater Vision.- a. Effect of Hyperbaric Oxygen.- b. Effects of Nitrogen.- c. Effect of Pressure.- References.- M. Breath-Hold Diving.- 1. Physiology.- a. Mammalian Dive Reflex.- b. Limits of Breath Holding.- c. Depth Limits of Breath-Hold Diving.- d. Acclimatization to Breath-Hold Diving in Man.- 2. Medical Considerations.- a. Drowning and Near-Drowning.- b. Cardiological Considerations.- c. Barotrauma.- d. Decompression Sickness.- e. Vertigo and Disorientation.- References.- IV Decompression Theory.- A. Introduction.- B. Defining the Problem.- C. The Haldane Concepts.- D. Using the Haldane Concepts.- E. Post-Haldane Difficulties.- F. U.S. Navy Initiative.- G. Diffusion vs. Perfusion.- H. Data From Tunnel Workers.- I. Bubble Generation and Growth.- J. Diving Tables Today.- K. General Observations.- References.- V Immediate Medical Evaluation of the Diving Casualty.- A. Introduction.- B. Emergency Care.- 1. General Statement.- 2. Divers Alert Network.- 3. Diving Medics.- 4. Immediate Action.- C. Diagnosis.- 1. Background.- 2. Air Embolism.- a. General Statement.- b. Signs and Symptoms.- c. Emergency Treatment.- 3. Decompression Sickness.- a. General Statement.- b. Symptoms.- c. Treatment.- 4. Determining the Cause of the Accident.- References.- VI Diagnosis and Treatment of Decompression Sickness.- A. General Survey.- 1. History.- 2. Symptoms and Signs.- a. Cutaneous and Lymphatic Symptoms.- b. Musculoskeletal Symptoms.- c. Central Neurological Symptoms.- d. Peripheral Neurological Symptoms.- e. Audiovestibular Symptoms.- f. Respiratory and Cardiovascular Symptoms.- g. Shock and Other Manifestations.- h. Aseptic Bone Necrosis.- 3. Diagnosis.- 4. Therapy.- 5. New Ideas.- References.- B. Inner Ear Decompression Sickness.- 1. Introduction.- a. Recent Human Studies.- b. Recent Animal Studies.- 2. Management of Inner Ear Decompression Sickness.- References.- C. Neurological Forms of Decompression Sickness.- 1. Overview and Introduction.- 2. Clinical Presentation.- a. Onset.- b. Signs and Symptoms.- c. Diagnosis.- 3. Mechanisms of Neurological Decompression Sickness.- 4. Prognosis.- 5. Concepts of Treatment.- a. Philosophy.- b. Initial Treatment.- c. Adjuvant Therapy.- d. Clinical Management.- References.- D. Delay After Decompression Sickness before Diving Again.- VII Diagnosis and Treatment of Gas Embolism.- A. Pulmonary Barotrauma and Arterial Gas Embolism.- B. Pulmonary Barotrauma.- 1. Introduction and Definitions.- 2. Intravascular Gaseous Emboli.- a. Effect on Pulmonary Circulation.- b. Cerebral Arterial Gas Embolism.- 3. Etiology of Pulmonary Barotrauma.- 4. Presentation and Diagnosis.- C. Arterial Gas Embolism.- 1. Presentation.- 2. Diagnosis.- 3. Therapy.- a. Pressure.- b. Oxygen.- c. Adjuvant Therapy.- 4. Relapse after Initial Response to Therapy.- 5. Other Considerations.- References.- VIII Near-Drowning.- A. Definitions.- B. Modifying Factors.- C. History.- D. Physiological Changes.- 1. Oxygenation and Acid-Base Balance.- 2. Anatomical Pulmonary Changes.- 3. Blood Volume and Electrolyte Concentrations.- 4. Cardiovascular System.- 5. Hematology.- 6. Renal Function.- 7. Central Nervous System.- 8. Infection.- E. Treatment.- 1. Immediate First Aid.- 2. Emergency Transportation.- 3. Emergency Room Care.- 4. Respiratory Care.- 5. In-Hospital Monitoring and Therapy.- 6. Brain Resuscitation.- 7. Corticosteroids and Antibiotics.- 8. Hyperbaric Oxygen Therapy.- 9. Summary.- Case Histories.- 1 Case No. 1: DD, 1972.- 2 Case No. 2: VYW, 1979.- 3 Case No. 3: CV, 1980.- References.- IX Diagnosis and Treatment of Other Diving-Related Conditions.- A. The Unconscious Diver.- 1. Factors Leading to Loss of Consciousness.- a. Relevant Physiology.- b. Predisposing Conditions.- c. Environmental Factors.- d. Physiological Factors.- 2. Recovering an Unconscious Diver.- a. Unconscious Diver in the Water.- b. Unconscious Bell or Habitat Diver.- 3. Resuscitation.- a. Check Vital Signs.- b. Insert Airway.- c. Mouth-to-Mouth Resuscitation.- d. Cardiac Resuscitation.- e. Treat Significant Bleeding.- f. Transfer Injured Diver.- g. Report the Incident.- References.- B. Osteonecrosis.- 1. Introduction.- 2. Diagnosis by Radiology.- a. Juxta-articular Lesions.- b. Head, Neck, and Shaft Lesions.- 3. Other Methods of Diagnosis.- 4. Clinical Management and Treatment.- 5. Underlying Pathological Changes.- 6. Etiology.- References.- C. Microbes and the Diver.- 1. Introduction.- 2. Cross-Infections.- 3. Diving with an Infection.- 4. Local Infections Associated with Diving.- a. Sinusitis.- b. Skin Infection.- c. Infections from Wounds, Bites, Stings.- 5. Systemic Infections.- a. Disease From Polluted Water.- b. Leptospirosis.- c. Pharyngoconjunctival Fever.- d. Near-Drowning.- References.- D. Ear and Sinuses.- 1. Otologic Barotrauma.- a. Middle Ear Barotrauma.- b. External Ear Canal Barotrauma.- c. Inner Ear Barotrauma.- 2. Otitis Externa.- 3. Inner Ear Injuries at Stable Deep Depths.- 4. Inner Ear Injuries and High Background Noise during Diving.- 5. Paranasal Sinus Barotrauma.- References.- E. Blast.- 1. Physical Aspects.- 2. Clinical Aspects and Pathology.- 3. Treatment.- 4. Prevention and Protective Measures.- References.- F. Dangerous Marine Life.- 1. Infections from Marine Microorganisms.- a. Infections Associated with Near-Drowning.- b. Tetanus.- c. Gas Gangrene.- d. Mycobacterium marinum Infections.- e. Erysipelothrix Infections.- f. Marine Vibrio Infections.- g. Coral Trauma Infections.- h. Marine Wounds.- i. Marine Fungal Infections.- j. Schistosome Cercarial Dermatitis.- k. Marine Viral Infections.- 2. Poisonous and Venomous Marine Organisms.- a. Blue-Green Algae.- b. Gymnodinium breve (Red Tide).- c. Dogger Bank Itch.- d. Green Algae (Phylum Chlorophyta).- e. Brown Algae (Phylum Phaeophyta).- f. Sponges.- g. Nematocyst Envenomizations.- h. Spine Puncture Envenomizations.- i. Venomous Octopus Bites.- j. Sea Snake Envenomizations.- 3. Human Toxic Ingestions.- a. Scombroid Poisoning.- b. Ciguatera Poisoning.- c. Puffer Poisoning.- 4. Marine Trauma.- 5. Conclusion.- References.- G. Spontaneous Pneumothorax.- References.- X Emergency Treatment While under Pressure.- A. Use of Drugs and Related Substances under Diving Conditions.- 1. Physiological Background.- a. Direct Effects of Pressure.- b. Interactions of Pressure and Gas.- c. Physical and Emotional State of Diver.- d. Known Interactions of Drugs with Environment.- 2. Clinical Applications.- a. Drugs Acting on Central Nervous System.- b. Cardiovascular Agents.- c. Respiratory Agents.- d. Otorhinolaryngeal Agents.- e. Antiallergenic Agents.- f. Antibiotics.- g. Abused Psychoactive Agents.- 3. Conclusions.- References.- B. Anesthesia for Emergency Surgery under High Pressure.- 1. Protection of the Airway.- a. Direct Visual Tracheal Intubation.- b. Blind Nasotracheal Intubation.- 2. Regional Anesthesia.- a. Toxicity of Local Anesthetics.- b. Techniques.- 3. General Anesthesia.- a. Inhalation Agents.- b. Intravenous Anesthesia.- c. Suggested Course of Action for General Anesthesia under High Pressure.- References.- XI Physical and Psychological Examination for Diving.- A. Physical Standards for Diving.- 1. Background.- a. Military Diving.- b. Commercial Diving.- c. Scientific and Technical Diving.- d. Semiprofessional Diving.- e. Recreational Diving.- 2. Physical Evaluation of Divers.- a. Age.- b. Sex.- c. Body Build.- d. Nervous System.- e. Ear, Nose, Throat.- f. Eyes.- g. Respiratory System.- h. Cardiovascular System.- i. Alimentary System.- j. Musculoskeletal System.- k. Skin.- l. Metabolic Disorders.- m. Genitourinary Disorders.- 3. Special Studies Required for Divers.- 4. Physical Fitness to Dive.- Appendix A.- Appendix B.- Appendix C.- Appendix D.- Appendix E.- References.- B. Psychological Standards for Diving.- 1. Recent Selection and Evaluation Research.- a. Mechanical and Arithmetic Aptitudes.- b. Age.- c. Demographic Factors, Medical History, Social Adjustment.- 2. Summary and Conclusions.- References.- XII Stress Physiology and Behavior Underwater.- A. Introduction.- B. Concept of Stress.- C. Stress in Diving.- 1. Training to Alleviate Stress.- a. Organized Training Programs.- b. Physician's Role in Training.- 2. Diver Motivation-A Stress Factor?.- 3. Physical and Physiological Stress Factors.- a. Fatigue.- b. Cold.- c. Cardiovascular Disorders and Sudden Death.- 4. Cardiovascular Effects of Stress: Emotional Factors.- D. Diving Accidents.- 1. Hazards and Accidents.- 2. Diving Hazards and Accidents.- E. Diver Panic.- 1. Helplessness and Anxiety.- a. Behavioral Reactions.- 2. Physiological Events in Panic.- a. Hyperventilation.- b. Hypoventilation.- F. Concluding Remarks.- References.- XIII Safety Considerations.- A. Introduction.- B. The Diver.- 1. Selection of the Diver.- a. Physical Examination.- b. Pyschological Evaluation.- c. Diving History Evaluation.- 2. Training.- 3. Predive Condition.- a. Age.- b. Drugs.- c. Alcohol.- d. Cigarettes.- e. Diet.- f. Obesity.- g. Fatigue.- h. Physical Condition.- i. Emotional Stability.- j. Infections.- k. Previous Diving History.- C. The Dive.- 1. Organization and Planning.- 2. General Safety Precautions.- 3. Personnel: Qualified, Trained, Ready to Dive.- 4. Natural Hazards: Environmental Conditions.- 5. On-Site Hazards.- a. Traffic.- b. Sonar.- c. Radioactive Contamination.- 6. Object Hazards.- a. Fouling.- b. Pollution.- 7. Special Situations.- 8. Recompression Chamber.- 9. Equipment, Regular and Emergency.- 10. Orientation.- 11. Diving Operations.- a. Diving Platform.- b. Warning Signals.- c. Line Signals.- d. Hand Signals.- e. Descent.- f. Fouling.- g. Explosives.- h. Electric Power.- i. Shark Defense.- j. Decompression.- D. Diving at Altitudes above Sea Level.- E. Flying after Diving.- F. Fire Safety.- G. Electrical Safety.- H. Blast.- I. Drowning.- J. Hazards of Marine Life.- K.Escape and Rescue.- 1. Submarines.- a. Escape.- b. Rescue.- 2. Submersibles and Habitats.- L. Ice Diving.- References.- XIV Equipment and Procedures.- A. Treatment Chambers.- 1. Multiplace Chambers.- a. Introduction.- b. Contributions of Caisson Work.- c. Contributions of Diving.- d. Contributions of Aviation.- e. Contributions of Clinical Chambers.- f. Development of Safety Codes.- g. Principles of Safe Treatment Chamber Operations.- h. Summary.- References.- 2. Monoplace Chambers.- a. Introduction.- b. Optimal Monoplace Chamber System.- c. Application of the Monoplace Chamber.- d. Maintenance and Safety.- e. Conclusion.- References.- B. Scuba Diving.- 1. Introduction.- 2. Development of Modern Scuba.- 3. The Scuba Diving Community.- 4. Scuba Procedures.- 5. Basic Scuba Diving Equipment.- a. Cylinder Group.- b. Regulator Group.- c. Masks, Fins, Snorkels.- d. Buoyancy Control Group.- e. Protective Clothing Group.- f. Instrument Group.- 6. Conclusion.- References.- C. Surface-Supplied Diving.- 1. Air Diving.- 2. Mixed-Gas Diving.- D. Deep Diving and Saturation Systems.- 1. Diving With a Deep Diving System: Deep Bounce Diving.- 2. Saturation and Saturation-Excursion Diving.- 3. Habitat Diving.- References.- XV Diving Accident Investigation.- A. Accident Reporting.- B. Objectives of Diving Accident Investigation.- 1. Human Factors.- 2. Environmental Factors.- 3. Equipment Factors.- 4. Other Factors Bearing on the Accident.- C. Authority for Investigation and Autopsy.- D. The Autopsy in Diving Accident Investigations.- E. Medical Investigation of Fatal Diving Accidents.- 1. Identification of Victim.- 2. Examination of Equipment.- 3. Total Body Radiography of Victim.- 4. Photographic Record of Investigation.- 5. Postmortem Examination.- a. External Examination and Search for Evidence of Injury.- b. Internal Examination and Search for Evidence of Injury.- c. Microscopic Examination.- d. Chemical and Toxicological Examinations.- e. Microbiological and Serological Examinations.- F. Summary.- References.- Appendixes.- Appendix A: Glossary.- Appendix B: Abbreviations and Acronyms.- Appendix C: Pressure Conversion Table.- Author Index.