Diving accident

Diving accident นต . คมสัน วุฒิประเสริฐ รน . กองเวชศาสตร์ใต้น้ำและการบิน กรมแพทย์ทหารเรือ

Classification of Diving Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Classification of Diving Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Barotrauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Boyle’s law ,[object Object],[object Object]

Boyle’s Law ,[object Object],[object Object],Surface 10 m 20 m 30 m 2 ATA 3 ATA 4 ATA 1 ATA 1/2 1/3 1/4 6 L 3 L 2 L 1.5 L 3 L 6 L 4 L {12 L}

Middle Ear Barotrauma of Descent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Middle Ear Barotrauma of Descent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Middle Ear Barotrauma of Ascent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Grade 0 - Symptoms without signs Grade 1 - Injection of the TM (especially along the handle of the malleus)

Grade 2 - Injection plus slight haemorrhage within TM Grade 3 - Gross haemorrhage within the TM

Grade 4 - Free blood in the middle ear Grade 5 - Perforation/Rupture of the TM

Inner Ear Barotrauma (Perilymph Fistula)

Inner Ear Barotrauma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Inner Ear Barotrauma ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sinus Barotrauma ,[object Object],[object Object],[object Object],[object Object],[object Object],Symptoms and Signs:

Sinus Barotrauma ,[object Object],[object Object],[object Object],[object Object],[object Object]

mask squeeze/ facial barotrauma

Facial Barotrauma of Descent ,[object Object],[object Object],[object Object],[object Object]

Pulmonary Barotrauma of Ascent ,[object Object],[object Object]

Pulmonary Barotrauma of Ascent ,[object Object],[object Object],[object Object],[object Object]

Decompression sickness. ,[object Object],[object Object],[object Object]

Henry’s law ,[object Object],[object Object]

Pathology - Bubble form first in tissue and then in venous blood - The lung are usually an effective filter for bubble ( pulmonary arterioles )

Pathology - The ability of lung to filter the bubble which then resolve by gas diffusion to the alveoli - Bubble can also be bypassed through anatomical defect  patent foramen ovale ( PFO)

Effects of Tissue Bubbles . ,[object Object],[object Object],[object Object],[object Object],[object Object]

Extravasations of fluid Increased hemoglobin concentration Progressive worsening of blood flow

Decompression sickness Type 1 - limb or joint pain ( bends ) Type 2 - sign or symptom ,cause by involvement of CNS , cardiopulmonary system Type 3 - DCS + AGE

Traditional Signs & Symptoms. ,[object Object],[object Object],[object Object]

More commonly experienced Signs & Symptoms. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Difficulty walking ache tired visual dist weakness vertigo chest pain dizzy itching light headed

DCS type 1 Bend Limb and joint pain only Skin rash

DCS type 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Spinal cord DCS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

First Aid. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patient Assessment. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Decompression Illness ,[object Object],[object Object],[object Object],[object Object],[object Object]

New guideline ,[object Object]

[object Object],[object Object]

Emergency air evacuation -Aircraft pressurized 1 ATA ( if possible) -Un-pressurized aircraft - no more than 1000 feet -Have the patient breath 100% oxygen during transport

Emergency air evacuation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diving accident

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Diving accident