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WINTER 2012
RESEARCH, EDUCATION & MEDICINE
must be in stable condition. Also, the patient must be
rehydrated before transportation and should breathe oxygen
during transportation. In cases of pulmonary barotrauma
with pneumomediastinum or pneumothorax, divers should
not travel aboard a regular airliner due to the risk of life-
threatening conditions from further expansion of gas
trapped within the chest.
If divers with DCS symptoms have no chance of reaching
a hyperbaric chamber without delay, what should they
do in the meantime?
Desola:
This is a difficult question; a very detailed and
complete evaluation over the phone or via video conference
is essential. The procedure will be different depending on
the assessed seriousness of the diver’s injury.
Noncritically Injured Divers
Injured divers who are in stable condition and whose
symptoms are no more severe than muscle pain, fatigue,
mottled skin or impaired sensation in an extremity can be
considered noncritically injured. These patients must not have
any serious symptoms such as bowel or bladder paralysis.
1.
A local physician or medical facility, if available, should
be contacted to examine and evaluate the diver.
2.
If no medical help is available locally, a detailed
phone evaluation should be conducted.
3.
Provided the injured diver is conscious, oxygen
and oral rehydration should be administered, and a
low dose of an anxiolytic and/or analgesic could be
considered if needed.
4.
An air evacuation should be organized using the first
available commercial or private aircraft. The patient
should be transported to a hyperbaric facility that can
provide adequate medical care. The facility should
be within a hospital and so may not be the nearest
hyperbaric chamber.
5.
Telephone contact with the target hospital-based
hyperbaric facility must be initiated.
Critically Ill or Injured Divers
This applies to cases in which there is bladder paralysis, shock
(low blood pressure, hemoconcentration and hypovolemia),
possible changes in consciousness or respiratory failure.
This includes severe cases of DCS as well as AGE caused by
pulmonary barotrauma and nonfatal drowning.
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