Diving Hyperb Med
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Vaso-occlusive crisis (VOC) is the most frequent complication of sickle-cell disease and is associated with significant acute bone pain. ⋯ HBOT is feasible in sickle cell disease and appears to be effective in reducing the pain of VOC rapidly.
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We present a case of cerebral venous gas embolism. Our patient made a complete neurological recovery after hyperbaric oxygen therapy (HBOT). The principles of HBOT, compressing and eliminating air bubbles and decreasing Β-2 integrin function, thus improving microcirculation, can only be beneficial in a situation where neurological damage is likely. ⋯ Its existence as a different entity is better recognised in the forensic medicine and radiology literature than in other disciplines. There is evidence in the literature of patients dying from this complication and others seemingly experiencing very little effect. This case report highlights this condition, to encourage others to look out for it and report outcomes, and to serve as a reminder that peripheral lines may be a potential cause of gas embolism, although the portal of air entry in our case remains uncertain.
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This study was designed to examine the influence of short delay to recompression and other risk factors associated with the development of severe neurological decompression sickness (DCS) in military divers. ⋯ Our results suggest that neurological severity upon occurrence is the main independent risk factor associated with a poor outcome in military divers with DCS. Clinical recovery was not dramatically improved in this series when recompression treatment was performed promptly.
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Some ventilated intensive care unit (ICU) patients may experience reduced oxygenation following hyperbaric oxygen treatment (HBOT). ⋯ Following HBOT, oxygenation is reduced in a majority of mechanically ventilated ICU patients and requires temporary alterations to mechanical ventilation settings. Further study to identify predictive characteristics and to determine causation for those at risk of needing ventilation alterations is required.
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Case Reports
Cerebral arterial gas embolism with delayed treatment and a fatal outcome in a 14-year-old diver.
In today's recreational diving climate, diving fitness examinations are not mandatory, and even divers who go for these examinations may not have routine chest X-rays (CXR) done in the absence of respiratory symptoms or a past history of respiratory problems. We present a case of an ultimately fatal cerebral arterial gas embolism in a 14-year-old boy with an undiagnosed lung cyst, the contribution of which to his death is uncertain. Various factors such as lack of oxygen first aid at the remote dive site; poor communication; lack of diving medicine expertise, poor oxygen administration and management in a local hospital and long delay to recompression therapy contributed to the poor outcome. It is imperative that dive operators and physicians working in close proximity to popular dive sites be educated on how to recognise and treat diving emergencies and be well-acquainted, as should divers, with the contact numbers of diving medical hotlines that offer timely and appropriate advice in case of emergency.