Cases reported "Decompression Sickness"

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11/99. Management of severe decompression sickness with treatment ancillary to recompression: case report.

    Recompression remains the primary form of treatment in decompression sickness, but severe cases require ancillary treatment. The case of a compressed air worker with decompression sickness is presented who, in addition to recompression, required 5.5 of I.V. fluids in the first 8 h, heparin, digitalis, steroids, and respiratory support, to prevent death. The report includes a description of the precipitation causes, the course during recompression, the drugs and dosages used, and comments on respirator treatment.
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12/99. altitude decompression sickness. Case presentation.

    The in-flight altitude-related decompression sickness (DCS) is not as common as DCS occurring after working or recreational diving, or, at least, it is not commonly described in the medical literature. Though modern aircraft are safer and more reliable, occupants are still subject to the stress of high altitude flight, and altitude DCS still represents a risk to the occupants, mostly if they are exposed to altitudes of 25,000 ft or higher. The authors report their experience about two different accidents involving a US Air Force pilot and a navigator, treated at the Service of Hyperbaric medicine at Landspitallin Fossvogur, the University of Reykjavik City Hospital, iceland, because of occurrence of type II altitude-related DCS. A US Navy oxygen Treatment Table 6 was successfully applied in both cases. Also considered are some aspects related to physiopathology, clinical presentation and therapy of DCS, with particular regard to the occurrence of DCS during flight.
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13/99. Epidemic decompression sickness: case report, literature review, and clinical commentary.

    BACKGROUND: decompression sickness (DCS) is a syndrome of symptoms caused by bubbles of inert gas. These bubbles are produced by a significant ambient pressure drop. Although cases are usually solitary there have been several episodes of DCS clusters. This paper reports an episode of epidemic decompression sickness and reviews the literature. methods: The case reported describes six aircrewmen with DCS following an unpressurized AC-130 flight (maximum altitude 17,000 ft). Two obvious concerns-the low altitude at which DCS was encountered and the potential for epidemic hysteria-are discussed and discounted. In addition, factors contributing to this case are recounted in depth. Moreover, the literature was examined for similar cases of epidemic decompression sickness. Four other instances were discovered. Detailed qualitative analysis of these five reports was performed. RESULTS: With this information epidemic decompression sickness is defined and classified. Two types are described-individual-based (Epi-I) and population-based (Epi-P). Epi-I is a cluster of DCS following a solitary exposure; whereas, Epi-P is a cluster of DCS following multiple exposures over time. Investigation of Epi-P follows the classical rules of outbreak investigation (time, place, person, and environment); whereas, Epi-I does not. In fact, the focus in Epi-I is almost entirely the environment. Following this outline should produce an etiology that control measures can be directed against. However, it is prudent to look beyond the etiology. Enter the Haddon Matrix, a classic public health tool that considers counter-measures before, during, and after the event. CONCLUSION: These many concepts are illustrated with the presented case. Following this template, both the expert and the novice flight surgeon have a systematic and reproducible approach to these difficult puzzles.
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14/99. Biophysical basis for inner ear decompression sickness.

    Isolated inner ear decompression sickness (DCS) is recognized in deep diving involving breathing of helium-oxygen mixtures, particularly when breathing gas is switched to a nitrogen-rich mixture during decompression. The biophysical basis for this selective vulnerability of the inner ear to DCS has not been established. A compartmental model of inert gas kinetics in the human inner ear was constructed from anatomical and physiological parameters described in the literature and used to simulate inert gas tensions in the inner ear during deep dives and breathing-gas substitutions that have been reported to cause inner ear DCS. The model predicts considerable supersaturation, and therefore possible bubble formation, during the initial phase of a conventional decompression. Counterdiffusion of helium and nitrogen from the perilymph may produce supersaturation in the membranous labyrinth and endolymph after switching to a nitrogen-rich breathing mixture even without decompression. Conventional decompression algorithms may result in inadequate decompression for the inner ear for deep dives. Breathing-gas switches should be scheduled deep or shallow to avoid the period of maximum supersaturation resulting from decompression.
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15/99. multiple sclerosis presenting as neurological decompression sickness in a U.S. navy diver.

    A case of clinically definite multiple sclerosis presenting as neurological decompression sickness is presented. A 23-yr-old U.S. Navy diver experienced onset of hypesthesia of the left upper trunk approximately 19 h after making two SCUBA dives. She did not seek medical attention until 3 wk later, at which time she was diagnosed with possible neurological decompression sickness. She was treated with hyperbaric oxygen, but demonstrated no improvement. Further evaluation led to the diagnosis of multiple sclerosis. This case underscores the potential similarity in neurological presentation between multiple sclerosis and decompression sickness. The differential diagnosis of neurological decompression sickness, particularly in atypical cases, should include multiple sclerosis. The appropriateness of medically clearing multiple sclerosis patients for diving is discussed.
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16/99. Differential diagnostic problems of decompression sickness--examples from specialist physicians' practices in diving medicine.

    It can be expected that the differential diagnosis problem of decompression sickness will increase in the future due to the increasing number of divers. During the last 30 years, 232 divers were treated for decompression sickness (DCS) at the Naval Medical Institute (NMI) in Split, croatia. In 66 cases (28%), physicians at various diving sites reached diagnosis with difficulty, and 86 divers (37%) came directly to the NMI without seeing a physician first. physicians at remote diving locations frequently have only basic knowledge of diving medicine and are often inexperienced. The language barrier was a major obstacle in obtaining a medical history and examination of foreign divers. Consultations at the NMI proved a major contribution to correct diagnosis and treatment. We present six illustrative cases from NMI archives that demonstrate how prejudices, panic, and inexperience could create problems in establishing DCS diagnosis.
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17/99. MR imaging of subclinical cerebral decompression sickness. A case report.

    diving accidents related to barotrauma constitute a unique subset of ischemic insults to the central nervous system. Victims may demonstrate components of arterial gas embolism, which has a propensity for cerebral involvement, and/or decompression sickness, with primarily spinal cord involvement. decompression sickness-related radiology literature is very limited. We present our MR findings including FLAIR images in a decompression sickness patient with atypical presentation and review the related literature. We believe MR can be useful in follow-up studies and in early diagnosis of decompression sickness when symptoms do not fit the classic picture or loss of consciousness in surfacing.
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18/99. Internal carotid artery dissection in stroke from SCUBA diving: a case report.

    Although diving with compressed air is generally safe, neurological problems resulting from infarction in SCUBA diving are well known, including arterial gas embolism and decompression sickness (caisson's disease, bends) involving the brain and spinal cord. While air gas embolism forms the overwhelming majority of causes for stroke in divers, internal carotid artery (ICA) dissection is another potential mechanism for central nervous system infarction in the setting of SCUBA diving. A 38 year-old female, who presented with complaints of headache, nausea, vomiting, and left sided hemiparesis after rapid ascent to the surface from a depth of 120 feet of seawater was initially treated for decompression illness in a hyperbaric chamber. Further neurological workup revealed a right ICA dissection. This case demonstrates the dangers of ICA dissection following rapid ascent to the surface from underwater and emphasizes an interesting presentation of stroke associated with SCUBA diving.
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19/99. altitude decompression sickness in a pilot wearing a pressure suit above 70,000 feet.

    U-2 pilots are at an increased risk of decompression sickness compared with other aviators in the U.S. Air Force. This is due to the extreme altitudes at which the missions take place. Presented here is a case of decompression sickness that occurred in a U-2 pilot who was wearing a full-pressure suit while flying at an altitude greater than 70,000 ft, with a pressurized cabin altitude of 29,200 ft. This case demonstrates the continued need for pilot education and awareness of DCS risk factors and symptoms.
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20/99. Diver with acute abdominal pain, right leg paresthesias and weakness: a case report.

    A 29-year-old man was brought to an emergency department by the united states Coast Guard with chief complaints of severe abdominal pain, right leg paresthesia and weakness following four deep air dives. physical examination before recompression treatment was remarkable for diffuse abdominal tenderness and right leg weakness. The patient was diagnosed in the emergency room with type II decompression sickness (DCS) and underwent standard recompression therapy. He experienced complete resolution of weakness after hyperbaric oxygen (HBO) therapy, but his abdominal pain was persistent. Further investigation led to the diagnosis of acute appendicitis with perforation. The patient underwent appendectomy and intravenous antibiotic therapy and was discharged to his home on hospital day five without complications. This case reinforces the importance of careful clinical assessment of divers and illustrates the potentially wide differential diagnosis of DCS. This is the first reported case of recompression treatment of a diver with acute appendicitis and type II DCS.
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