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Concept: Undersea and Hyperbaric Medical Society

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In 2015 the German Society for Diving and Hyperbaric Medicine (GTÜM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100 % oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy.

Concepts: Oxygen toxicity, Decompression sickness, Diving medicine, First aid, Undersea and Hyperbaric Medical Society, Medicine, Oxygen, Hyperbaric medicine

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To analyze the efficacy of hyperbaric oxygen for the treatment of radiation-induced hemorrhagic cystitis and to identify factors associated with successful treatment.

Concepts: Medical treatments, Undersea and Hyperbaric Medical Society, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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Hyperbaric oxygen therapy (HBOT) is defined as breathing 100% oxygen at a pressure ≥1.4 atmospheres absolute (ATA). Adjunct HBOT is one modality used for treatment of certain complex wounds. The resulting increase in oxygen delivery to wounded tissue has been associated with reduced edema, reduced inflammation, improved infection control, increased collagen deposition, and increased angiogenesis. However, there remains a relative paucity of evidence supporting the use of HBOT in the treatment of certain acute and chronic, non-healing wounds. This feasibility study was undertaken to evaluate the ability of fluorescence angiography to provide real-time visualization and objective assessment of changes in local tissue perfusion over a standard course of HBOT.

Concepts: Undersea and Hyperbaric Medical Society, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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The present study was carried out to evaluate cerebral perfusion in multiple sclerosis (MS) patients with a moderate to severe stage of disease. Some patients underwent hyperbaric oxygen therapy (HBOT) and brain perfusion between before and after that was compared.

Concepts: Undersea and Hyperbaric Medical Society, Multiple sclerosis, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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Hyperbaric oxygen therapy (HBOT) is used for the treatment of chronic diabetic foot ulcers (DFUs). The controlled evidence for the efficacy of this treatment is limited. The goal of this study was to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with diabetes and chronic DFUs.

Concepts: Randomized controlled trial, Undersea and Hyperbaric Medical Society, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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Hyperbaric oxygen therapy (HBOT) is defined as a treatment in which a patient intermittently breathes 100% oxygen while the treatment chamber is pressurized to a pressure greater than sea level (1.0 atmosphere absolute, ATA). In China, for nearly 50 years, HBOT has been used as a primary or adjuvant therapy to treat a variety of diseases. This article mainly reviewed the indications and contraindications of HBOT, as well as the status of clinical and experimental HBOT research in China. At the same time, there is a brief introduction of hyperbaric oxygen preconditioning (HBO-PC) in China.

Concepts: Undersea and Hyperbaric Medical Society, Atmospheric pressure, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1-3%. A significant number of patients who survive CO poisoning suffer from long term neurologic and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels, but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15-40% of patients while approximately one third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed post-hypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. While hyperbaric oxygen significantly reduces the permanent neurological and affective effects CO poisoning, a portion of survivors still remain with substantial morbidity. There is some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development.

Concepts: Medicine, Carbon dioxide, Poison, Undersea and Hyperbaric Medical Society, Hemoglobin, Carbon monoxide poisoning, Carbon monoxide, Oxygen

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The present study aimed to evaluate the effects of using hyperbaric oxygen therapy during post-training recovery in jiu-jitsu athletes.

Concepts: Medical treatments, Undersea and Hyperbaric Medical Society, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen

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This study reports on the case of an elderly patient, with diabetes, and a bullous wound on the left big toe that led to an amputation of the first and second left toes. The amputation was because of deep injury as it was not able to heal with a conventional treatment. After completing the normal treatment and the removal of a bacterial infection in the lesion, the patient underwent a treatment that was based on a hydrogel gel (0.9% saline solution) and hyperbaric oxygen therapy (HBOT). After 60 sessions of the therapy, almost complete closure of the wound was observed. There were no reports of discomfort or infection during the treatment. After seven months of treatment almost complete healing was observed with no infection. This treatment appears to be effective and should be recommended for the treatment of DFUs.

Concepts: Toe, Undersea and Hyperbaric Medical Society, Oxygen mask, Decompression sickness, Diving medicine, Oxygen toxicity, Hyperbaric medicine, Oxygen