1 / 60

Dive Travel

Dive Travel. Edmond Kay MD. Acknowledgements. Dr Richard Moon, Divers Alert Network Jack Connick, Optical Ocean. Declarations. Topics. Before traveling fitness issues medication While traveling DAN dive & travel insurance region specific precautions Unwanted souvenirs nasties

ilana
Download Presentation

Dive Travel

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dive Travel Edmond Kay MD

  2. Acknowledgements • Dr Richard Moon, Divers Alert Network • Jack Connick, Optical Ocean

  3. Declarations

  4. Topics • Before traveling • fitness issues • medication • While traveling • DAN dive & travel insurance • region specific precautions • Unwanted souvenirs • nasties • Bubble trouble • decompression illness

  5. Gravity & Momentum

  6. Pressure & Immersion

  7. Boyles Law Pressure and Volume - Inversely Proportional

  8. Henry’s Law Amount of gas dissolved in a liquiddirectly proportional to the partial pressureof that gas On surface On decent At pressure

  9. Recreational Diving: DCS and Death N Divers Alert Network, 1998

  10. What kind of Diving “Fitness to dive should apply only to the type of diving in which the diver plans to engage” - David Elliott, MD, OBE Moon RE

  11. What kind of Diver • Not fit right now- dehydration, fatigue, URI, pregnancy • Not fit withoutspecial training • ADA - accommodation - supervision Adapted from Moon RE

  12. Fitness to Dive • Able to do the “work”: breathe, swim, exercise • Not susceptible to barotrauma:ear, lung, GI • Not susceptible to loss of consciousness (drowning): convulsions, insulin dependent diabetes, heart block • Not pregnant • No diseases that diving could make worse:sinus or middle ear disease, previous labyrinthine window rupture, heart failure • Not ‘overly’ susceptible to DCI Age? Female gender? Obesity? Menses? Previous decompression illness? Fatigue, dehydration? Orthopedic injuries or surgery? Atrial septal defects, PFO? Moon RE

  13. Psychological & Behavioral Fitness? • Able to exercise good judgment • Not susceptible to disabling anxiety • No sedating drugs - alcohol & tranquilizers • ADHD - oppositional & defiant • Psychosis, Mania

  14. How to Determine Fitness to Dive “If you don’t have gills, the term ‘fitness to dive’ is a misnomer”- Andy Veale MD • What incremental risk is acceptable? • Where should the threshold for qualification be set? "It's probably more important to ask if someone has ever run out of gas on the freeway than to ask about most medical conditions” - Tom Neuman MD Adapted from Moon RE

  15. Barotrauma

  16. Squeeze • MIDDLE EAR SQUEEZE • MIDDLE EAR OVERPRESSURE (REVERSE BLOCK) • EXTERNAL EAR SQUEEZE • SINUS SQUEEZE • SINUS OVER PRESSURE (REVERSE BLOCK) • TOOTH SQUEEZE (BARODONTALGIA) • BODY (SUIT) / FACE (MASK) SQUEEZE • STOMACH / INTESTINE • INNER EAR BAROTRAUMAS • PULMONARY OVER INFLATION SYNDROMES

  17. Sinus Barotrauma

  18. Ear Barotrauma • Most frequent diving injury • Common in novice divers • Poor understanding of equalization techniques • Middle Ear Barotrauma is… Preventable

  19. What is “Ear Fear”? • Pressure perceived as “uncomfortable” • Childhood pain  adult fear • Retrograde tear duct inflation • Confusion over instructions

  20. Assessing Valsalva Effectiveness • Watch The Nose Inflate! • Fingers low on nose • Palpate firmness of inflationand compare it to your own pressurization effort • Watch the pars flaccidaof the Tympanic Membrane balloon out,“like a sail catching the wind”

  21. Normal Ear

  22. Hemotympanum

  23. Video Otoscopy divingdoc.com

  24. Ear Clearing Techniques • Valsalva Maneuver (1704) • Frenzel Maneuver (1932) • throat piston • BTV (Voluntary Tubal Opening) • distilled yawn • Lowry Technique (combinations) • pressurize and swallow • pressurize and yawn

  25. Pulmonary Issues • Air Flow • Air Trapping

  26. Maximum Voluntary Ventilationvs.Gas Density 100 75 MVV (fraction of 1 ATA) 50 25 0 0 100 150 200 50 Depth (fsw) Adapted from Moon RE

  27. CXR - 1 view or 2?

  28. Bleb visible – Lat only

  29. CT view

  30. Chest CT after PBT in Divers AGE Pneumomediastinum Reuter et al. Br J Radiol 70:440, 1997

  31. Unrestricted Clearance ? • Normal exercise tolerance • Normal PFT • Forced vital capacity (FVC) • Forced expiratory volume in 1 second (FEV)1 • No significant reversible obstruction • Improvement < 12% (BD) • Change not greater than 200 cc (BD) Moon RE

  32. Diving and Asthma

  33. Recommendations for Diving with Asthma • No symptoms attributable to asthma • Normal physical exam • Normal spirometry before and after exercise provocative test with or without medication Elliott (Ed). Are Asthmatics Fit to Dive? UHMS, 1996

  34. Seizure Risk • Seizures underwater are likely to be fatal • It is possible that the physiological conditions during diving (hyperoxia, hypercapnia, immersion) could lower the seizure threshold • People with recurrent seizures should not dive Moon RE

  35. Seizure • 50% of adults with new onset seizures, normal neurological exam and brain imaging will have another seizure • Risk increased with family history, abnormal EEG, previous head injury • 14 years after a first seizure the risk of a second one is several fold greater than in the general population

  36. Coronary Artery Disease

  37. Recreational Diving Fatalities USA Moon RE

  38. Cause of Death Denoble PJ, Caruso J, Dear G de L, Pieper CF, Vann RD, 2007

  39. Redistribution of Blood During Immersion

  40. Heart Failure • Immersion causes a displacement of 500-800 ml of blood from the legs into the thorax. This is even greater during cold water immersion • If the patient’s ventricle is unlikely to tolerate a sudden 500 – 800 ml transfusion, diving (swimming?) should be restricted Moon RE

  41. Coronary Artery Disease • Patients with coronary artery disease are at risk of myocardial infarction and sudden death (60%) • Cardiac work is related to contractility, heart rate, afterload and preload. Preload is higher during immersion than in the dry • No diving if CAD. If patient has risk factors for CAD, rule out with exercise test (13 METS) Moon RE

  42. Effect of Head and Torso Water Temperature on Hemodynamics Wester TE, et al. J Appl Physiol 106: 691, 2009

  43. Fitness to Dive: Obesity- 2004 Diving Report NIH Definitions Based on BMI Moon RE

  44. Stings & Punctures

  45. OUCH!

  46. Jellyfish Precautions

  47. Irukandji Syndrome • One of the most venomous jellyfish • Severe headache, backache, muscle pains, chest and abdominal pain, nausea and vomiting, sweating, hypertension • EXTREMELY painful"rip your skin off"

  48. Bubble Trouble Decompression Sickness Arterial Gas Embolism

More Related