Wednesday, December 29, 2004

SCUBADOC'S TEN FOOT STOP NEWSLETTER, DEC. 31, 2004

SCUBADOC'S TEN FOOT STOP NEWSLETTER, DEC. 31, 2004
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It's Friday! Here's our last newsletter for 2004.
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BUT FIRST, A small amount of business....

As I noted in my special letter to you last week - for various reasons we are discontinuing the use of PayPal for your contributions to our web site and newsletter. We will continue to use amazon.com and snail mail for those of you who wish to continue donating on a regular basis. Let me say thank you for your help that goes a long way toward providing appropriate services for this "one man operation".

Subscribe at http://scuba-doc.com/sbscrb.html

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==> CHANGING YOUR E-MAIL ADDRESS?<== Don't miss a single issue. Update your subscription e-mail address: Send both you old and new email addresses and we'll make the change immediately. scubadoc@scuba-doc.com

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==>NOTE FROM SCUBADOC <==
.. Lend a hand to tsunami victims

The human tragedy caused by the recent earthquake and tsunami in Asia and Africa is overwhelming. You can help.

Organizations are accepting donations of cash and specific supplies. Kim Komando has put together a listing of Web sites to assist victims.

Please be aware that many of the Web sites listed are experiencing heavy traffic. If you're unable to connect the first time, try again
later. You'll be glad you did.

TO VISIT THIS SITE, GO HERE:
http://www.komando.com/giveaid.asp

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More about the tsunami - and the post traumatic stress syndrome from Dr. David Colvard.

Last night I rewrote my website to provide practical information about the
development and prevention and treatment of PTSD to help the victims of the
Dec26-Tsunami:

www.DivePsych.com

Please let them know.


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For later in January 2005:

A post-Dec26-Tsunami PTSD (Post Traumatic Stress Disorder) study of divers
and snorkelers and swimmers who were in/on/near the water when the tsunami
hit their location is being prepared.

I would greatly appreciate assistance in contacting anyone who was
in/on/near the water when the tsunami hit their location or who know of
anyone who was in/on/near the water when the tsunami hit their location,
including dive operators, etc.

They may contact me directly by email at dcolvard@mindspring.com
or by going to www.DivePsych.com.

Participation will be entirely voluntary. At this time the study does not
have external funding.


David F Colvard, MD
Diplomate of the American Board of Psychiatry & Neurology
ACRP Certified Clinical Research Investigator
Divemaster
3725-228 National Dr
Raleigh, NC 27612 USA

Office 919-781-3141
FAX 919-781-3141
Email: dcolvard@earthlink.net
URL: www.drcolvard.com and www.divepsych.com
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How “Tough” is Your DAN Oxygen Unit?

DAN Oxygen Units and First Aid Kits in watertight green Pelican® cases are seen at most dive sites around the U.S. and the Caribbean. In fact, it is the single most identifiable Pelican case in diving.

Has the green Pelican case protecting your DAN Oxygen Unit or First Aid Kit gone above and beyond the normal call of duty? If so, here now is an opportunity for you to tell your story or show pictures of it and earn more gear in the process.

Pelican Products recently announced its “Pelican Tough” photo contest. Running from Nov. 15, 2004-Feb. 28, 2005, contestants have a chance at a share of nearly $5,000 worth of Pelican gear prizes in three different categories: Most Scenic; Most Adventurous; and Best Story. Winning photos and stories must feature Pelican cases and lights. Full contest details can be found at www.DiversAlertNetwork.org/news/article.asp?newsid=503.

If your story or photo features a DAN Oxygen Unit or First Aid Kit in a green Pelican case, DAN would like to know about it as well. In addition to submitting your entry to Pelican, send a copy to DAN at 6 W. Colony Place, Durham, NC 27705, phone +1-919-684-2948 or 1-800-446-2671 (toll-free), fax +1-919-490-6630, or email pelican@DiversAlertNetwork.org. Selected photos and stories may be featured on the DAN website and in DAN literature.

For more information regarding Pelican Products, write Pelican at 23215 Early Ave., Torrance, CA 90505, phone 1-800-473-5422 (outside California) or +1-310-326-4700, fax +1-310-326-3311, email sales@pelican.com or visit www.pelican.com . For more information regarding DAN Oxygen Units and First Aid Kits, visit www.DiversAlertNetwork.org.

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“I’d like to use DAN oxygen equipment, but it costs too much.”

Forget that statement. Divers Alert Network has taken action for those who want safety at a price that will not bust their budgets with a new line of lower-priced DAN oxygen units to supplement its current oxygen equipment. Just remember these key letters – BF.

You see, the new units will use the B & F multifunction regulator, and coincidentally they are “Budget Friendly.” Hence the product names – the DAN BF Rescue Pak, the DAN BF Rescue Pak Extended Care and the DAN BF Dual Rescue Pak Extended Care.

As with the standard DAN Rescue Paks, these items contain DAN Oxygen Units able to deliver 100 percent oxygen to an injured diver. They still come in the waterproof DAN Green Pelican case – the single most identifiable piece of dive safety equipment at dive sites today. They also include the B & F brass multifunction regulators that allow treatment of two divers with both constant-flow and / or on-demand using a DAN demand valve to provide the injured diver with the highest concentration of oxygen in an efficient manner. All oxygen units can be upgraded with the MTV-100 (flow-restricted oxygen-powered ventilator). The differences between the units are the size and available oxygen in the cylinders used – the DAN BF Rescue Pak will last approximately 20 minutes, the DAN BF Rescue Pak Extended Care will last approximately 60 minutes and the DAN BF Dual Rescue Pak Extended Care will last approximately 120 minutes.

Now, for a limited time, Divers Alert Network is offering the new DAN BF Rescue Pak for less than $400. Contact DAN for details.

DAN is rolling back the calendar on oxygen equipment pricing – these new special prices are lower than what DAN charged for oxygen units in 1995. Prices on all DAN oxygen equipment, including the DAN BF Rescue Pak Extended Care and the DAN BF Rescue Pak Extended Care, have been lowered with this special offer.

Research and experience by DAN and its members have shown there are still some areas and divers without the equipment they should have for emergencies. By offering another lower-cost option, DAN hopes to make it possible for more divers to have emergency oxygen equipment and save lives.

To order any DAN BF Rescue Pak or other oxygen equipment at reduced prices, contact Divers Alert Network at +1-919-684-2948 or 1-800-446-2671 toll-free, fax +1-919-490-6630, or visit the product catalog on the DAN website at www.DiversAlertNetwork.org/catalog/index.asp.


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==> QUESTION OF THE WEEK <==
GERD?, DCS?, Labyrinthitis?

Here is a question with multiple facets that we referred to our able consultant, Martin Quigley, MD. The back and forth responses are interesting and enlightening.

Question:
I noticed that there is such a phenomenon as diving induced GERD. I had never had a case of acid reflux until iIdove in cozumel last feb. After a few days of diving I had some bouts of dizziness coupled w/itching. I immediately thought the worst, however all of my dives were no deco dives and I'm pretty safe. I flew back home a few days later as scheduled. My symptoms continued along w/ mild chest pain. After going to the hospital and having a gamut of tests run, all it took was a few nexxium to bring me back to normal. Well, I figured I was "good to go".
I recently returned from another week of diving. Well, the same thing happened, except this time I feel more dizzy and the chest discomfort is not really there. It's been six days since my last dive. I did not go into deco on any dive and made three min. safety stops on every dive. I started the nexxium last night but it has not helped. Is there a chance I could be suffering from a very mild form of DCS? If not, can you help render a Dx???

Dr. Quigley's Answer:

Dear Diver,

DCS is a very funny condition, the symptoms are variable and it sometimes happens to divers who have stayed within the NDL limits and observed all the other "rules".

There are certainly many aspects of scuba diving that can produce GERD symptoms - tight wet suits, over-inflation of BCDs, air swallowing, etc.Dizziness and itching are not generally symptoms of GERD.

If you are still symptomatic, I would suggest that you be evaluated by a physician experienced in diving medicine [check with DAN 1-919-684-4DAN (collect) or 1-800-446-2671 (toll-free) for a physician in your area.] It may well take a trail of recompression (hyperbaric chamber) to determine if your symptoms are indeed due to DCS. If your symptoms resolve with re-pressurization, then they are likely due to DCS.
Martin M. Quigley, MD

Writer's Credentials: Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology. Trained in Diving and Hyperbaric Medicine by NOAA and UHMS. Current PADI Instructor. Certified Cave and Trimix Diver. Faculty Member at DAN's 2001 and 2005 Dive Medicine Courses.

Diver's Answer and responses from Dr. Quigley:
Dr. Quigley,
Thank you very much for your time. I am a young dentist but I do understand what being busy at the office is all about! I feel a little better today. From my reading, it seems very unlikely that DCS can be present one week after the last dive was made with nothing more than intermittent dizziness being the main symptom. The itching has nearly gone away. It might be prudent to note that I was diving w/ a small group the entire time that dove pretty much the same profile as me w/ no adverse effects. I have no muscle or joint pain, no nausea, no skin rashes or erythematous areas. It's just odd that this happened last feb. in a similar manner. I started the nexxium last night so I will certainly give it time to work. I know for a fact that I do hold my breath while i'm diving to conserve air. I did not realize that this could trigger GERD.
I guess ultimately the question is... is it possible to have such a mild form of DCS that one could experience symptoms (mild), continue to dive, and fly home without risking serious injury and the DCS still being present. If so, I need to get checked out. If not, can dizziness be present as one of the symptoms of GERD in my case and resolve in a short period of time?
I know you are busy. I do appreciate your time in this matter because I am still worried; I am a 29 year old healthy male who exercises regularly...
Thanks so much for your time and please let know if there is anything i can do for you
Sincerely,

Dr. Quigley responded:
DCS is funny - it's unusual to have symptoms that begin more than about 12-24 hours after a dive, but flying after diving (within 12-48 hrs) can cause symptoms. Once symptoms occur, they can persist long after the last dive. There's much individual variation in susceptibility to DCS, small differences, such as differences in ascent rate, may be an explanation.
If your symptoms are resolving, I'd guess that I'd not worry. But if they ever recur after diving in the future, I'd get them checked out promptly.

Diver's response:
I just wanted to let you know that using my better judgment i heeded your advice and went to see the director of the hyperbaric medicine unit. I do not have DCS but rather he suggested i may have labrynthitis. sometimes we younger divers forget the basic principles and now looking back i realize i ascend much faster than i should. it should take 1 min. 30 sec. to go from 60 ft. to the safey stop bar at 15 ft. when in actuality i do it in at least half that time. i also have a tendency to hold my breath to extend bottom time. now after being yelled at i know these are bad habits!
thanks again for devoting your time and expertise to help make diving safer for the rest of us...
sincerely,
Last word from Dr. Quigley:
Actually, fast ascents are one of the main suspects in causing DCS. Fort the last several years I've been stopping for 1-2 minutes at 1/2 my maximum depth (e.g. 50 fsw for a 100 fsw dive) and then do 3-5 minutes at 10-20 feet. 20 feet/min is the maximum rate you should go from 20 fsw to the surface. Breath holding ("skip breathing") can lead to an increase in carbon dioxide levels which, in itself, may be a risk factor for DCS. I think you've been given good advice. [By the way, labrynthitis can be a symptom of DCS.}

Related Links
Heartburn and Peptic Disease
Labyrinthitis, Inner ear dysfunction

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==> COOL NEW WEB PAGE ON DIVING MEDICINE ONLINE <==
ADD/ADHD and Diving?

We often get questions from parents and instructors about scuba diving with attention deficit disorder [ADD] and attention deficit hyperactive disorder [ADHD]. Because of the frequency and interest in these conditions and the increased interest in children diving, I have developed a web page concerning these conditions. Linked at http://scuba-doc.com/psyc.html, it can be directly accessed at http://scuba-doc.com/ADDADHD.html . Your input about this interesting problem would be appreciated.

DAN's Article on ADD

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==> Unusual Diving Medical Question from the Archives<==
In our January 31, 2004 issue is a query about piranha bites in scuba divers.

Question about Piranha bites in scuba divers: We have many dammed up rivers in Brazil that are full of piranha. Are there any reports of divers being attacked by these fish?

Answer:We have had no questions or reports of scuba divers being attacked or bitten by piranha. However, we have found a report in Wilderness and Environmental medicine that deals with piranha bites. The abstract of this article can be seen here. A piranha bite is unlike the bite of any other animal in that it results in a 100% loss of flesh. They are equipped with powerful jaws and razor sharp triangular teeth that neatly fit together in such a way that there are no gaps. The resulting wound from a piranha bite has a smooth surgical look to it. There are no abrasions or puncture marks but rather a complete tissue loss. If you are bitten while diving, get out of the water immediately and initiate the following steps:

  1. Stop bleeding
  2. Clean well with a brush, soap and water
  3. Scrub and debride foreign particles
  4. Bed rest, elevation, antibiotics for severe cuts
  5. Be aware of danger of anaerobic infection and clostridial infection
  6. Topical antibiotics
  7. Tetanus prevention

Photo of a piranha bite on the hand of a child.
http://snipurl.com/47b6

Photo of another piranha bite of the hand. http://www.lunkerlink.com/piranha.html

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==> INTERESTING LINKS <==

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Obesity may increase Mountain Sickness risk
http://www.paktribune.com/news/index.php?id=88102

Related Link

Obesity and DCS

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Opinion: The Ultimate Public Library

Google, the world's most popular Internet search engine, has announced plans to put the holdings of great libraries online and in searchable form.

Google has announced agreements with Oxford, Harvard, Stanford, the University of Michigan and the New York Public Library, to scan large parts of their non-copyrighted collections and make them freely available.

http://tinyurl.com/6bqf7

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From wetdoc (Omar Sanchez, MD)
Whales, Like Humans, Get Decompression Sickness From Deep Dives
http://tinyurl.com/6bmus
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Scuba Fitness Staying Active During the Winter Months
http://scuba.about.com/od/divemedicine/a/fitness.htm

Related Links
Travel Exercises
Exercises for Abs
Physical Fitness for Sports Divers
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Marine Neurotoxins: Envenomations and Contact Toxins.
http://snipurl.com/be7r

Related Links
Hazardous Marine Life

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Diving-related fatalities caused by underwater explosions: a report of two cases.
http://snipurl.com/be7i

Related Link
Underwater Blast Injuries
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Current problems in prophylaxis and treatment of acute decompression disease of mild degree
http://snipurl.com/be7h

Related link
Decompression Accidents
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Before going on a diving holiday--consider this]
http://snipurl.com/be71

Related Link
Fitness for Diving
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Scuba diving and the heart. Cardiac aspects of sport scuba diving]
http://snipurl.com/be74

Related Link
Heart Problems and Diving
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Submarine escape from depths of 30 and 60 feet: 41,183 training ascents without serious injury.
http://snipurl.com/be7a

Related Google links
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Validation of diving decompression tables.
http://snipurl.com/be7d

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Delayed onset pulmonary barotrauma or decompression sickness? A case report of decompression-related disorder.

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New from Larry "Harris" Taylor:
International Diving Institute: http://www.internationaldivinginstitute.com/
Conserve Our Ocean Legacy: http://www.oceanlegacy.org/

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==> MAILBOX POTPOURRI <==
Dr. Larry Stein, our 'toothdoc' gets recurring questions regarding diving with temporary crowns. Here is the latest and his answer.

Question:
.....Diving with a temporary crown (no root canal). Is it advisable? It seems to be on solid... Barotrauma?
Answer:
Scubadoc forwarded your question to me.

I do have reservations about diving with a temporary crown but it is not because of dental barotrauma.

You indicate that the affected tooth does not have a root canal. In this case a properly fabricated temporary crown shouldn't have any air spaces to cause trauma.

My concern however, is that the temporary is....temporary! By its very nature, the temporary is supposed to be removable. Unfortunately, we can't alway control when it gets removed. In the event the temporary were to come loose during a dive, it can become an aspiration hazard. The weakest link is the temporary cement. It doesn't stick to either the temporary plastic or the tooth. It is meant to fill the space between the tooth and the temporary. The plastic used is also brittle. Excessive pressure can break it. Either way it can come loose forming pieces that can be inhaled. Forget a sensitive tooth. If the temporary comes off and it is inhaled it can induce a laryngospasm. Simply having a foreign object touching the vocal cords...even momentarily...can close the windpipe.
The temporary can even get into the mainstem bronchus and then be inhaled further into the individual lungs. How far it can go is anyone's guess. Now, you can have a pulmonary obstruction and THAT can become a barotrauma problem.
If you manage to survive the dive, someone is going to have to get the crown out of the lungs. Nearly all temporary crowns except perhaps prefabricated metal temporaries are radiolucent...they are not visible on an x-ray. Determining which bronchus or lung it is lodged in is more difficult. There will be diminished breath sounds on the affected side. In order to get the temporary out of the lung, you'll have to be sedated and a bronchoscope will have to be used to retrieve the temporary. The deeper within the lung it is lodged, the more difficult the removal.
All this being said, I am personally unaware of any particular dive accident involving the aspiration of a temporary crown. Perhaps Scubadoc has an insight into that possibility.

If possible, try to have the permanent crown completed before you next dive. You're usually looking at two weeks max. If you have made plans to dive that cannot be changed, the only advice I can offer you is to have your dentist cement your temporary crown with a very strong temporary cement or even a permanent cement. He should still be able to remove the temporary possibly with some difficulty. He might even break the temporary...which is not too much of a problem
unless the temporary must be used again. The permanent cement will also stick to the tooth and must be removed (with difficulty) before the permanent crown can be cemented.

Temporaries can also be loosened or removed by chewing gum or eating candy...anything with sugar will stick to it. You want to avoid chewing ice, hard nuts or the un-popped kernels of popcorn at the bottom of the bucket at the movies.

If you are going out of town to dive and must dive with the temporary, carry a package or two of temporary cement from the pharmacy. You can find them in
the dental section.

If you have more questions just let me know.

Happy holidays

Laurence Stein, DDS

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Lisa Wasdin, with UHMS, sends these job opportunities with Praxis.

PROGRAM DIRECTOR - RN

Praxis Clinical Services, a leading national provider of wound care and hyperbaric oxygen therapy services seeks a PROGRAM DIRECTOR for its center at Tennessee Christian Medical Center in Madison, TN.


Ideal candidate will be an RN with strong experience in wound care and hyperbaric oxygen therapy (preferred). The candidate will also have experience in employee supervision, department management, and sales/ marketing. Proficient in business software.


Education/Experience: RN (BSN or higher preferred). Currently licensed in the state of Tennessee. Woundcare and Hyperbaric Oxygen Therapy (HBO) experience, minimum 3 years healthcare management experience, marketing experience preferred. BLS certified, ACLS strongly recommended. Special training provided. Strong communication skills are essential.

We offer a competitive benefits package.

Visit our website at: www.praxisusa.com

Email resume w/salary required to:

Belinda Blair, Regional Director of Operations

at bblair@praxisusa.com

or fax to 270-689-1216

Praxis is an Equal Opportunity Employer.

_______________________

REGIONAL DIRECTOR OF OPERATIONS POSITION

Northeast - New Jersey and Pennsylvania

Full Time

Praxis Clinical Services, Inc.. is seeking a Regional Director of Operations (RDO) with management level skills for our Northeast Region. This Regional Director must be actively licensed in their residing state. This position directs the operations, programs, and activities of all Comprehensive Wound Healing Centers and Hyperbaric Oxygen Therapy units within their defined region. They must actively demonstrate expertise and knowledge of wound healing practices.

Job Description:

· In conjunction with the Vice President of Clinical Services, and the Director of Quality Services, the RDO ensures ongoing compliance of all sites to Praxis Clinical Services Policies and Procedures, and adherence to all state and federal regulations, such as JCAHO, HCFA, etc.

· Works closely with Medical Directors and Program Directors to increase volume of business and manage expenses.

· Completes on-going site assessments. Ensures the plan for any needed corrective action.

· Serves as liaison between Praxis Clinical Services, Inc. and all hospital personnel.

· Establishes and implements Praxis’ Quality Improvement Plan.

· Ensures local Safety Director is in place, trained and properly completing safety procedures.

Job Requirements:

· Clinical/Business Degree;

· 5-10 years of progressively responsible management experience;

· Current clinical license in the state(s) residing;

· Hospital based and multi-site experience preferred;

· Marketing and Business Development experience preferred; and

· BLS Certified

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

J. Chandler, Human Resources, (714) 579-8329 FAX or,

Email to jchandler@praxisusa.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

__________________________________

PROGRAM DIRECTOR - RN

Praxis Clinical Services, a leading national provider of wound care and hyperbaric oxygen therapy services seeks a PROGRAM DIRECTOR for its center at Gottlieb Memorial Hospital, Melrose Park, IL.


Ideal candidate will be an RN with strong experience in wound care and hyperbaric oxygen therapy (preferred). The candidate will also have experience in employee supervision, department management, and sales/ marketing. Proficient in business software.


Education/Experience: RN (BSN or higher preferred). Currently licensed in the state of Illinois. Woundcare and Hyperbaric Oxygen Therapy (HBO) experience, minimum 3 years healthcare management experience, marketing experience preferred. Special training provided. Strong communication skills are essential.


We offer a competitive benefits package.

Email resume w/salary required to:

Don Uhlmeyer at duhlmeyer@praxisusa.com

Fax to D.Uhlmeyer @281-298-1570

Praxis is an Equal Opportunity Employer

_________________________________

PROGRAM DIRECTOR, Wound Healing Center

Praxis Clinical Services is a leading national provider of wound care and hyperbaric oxygen therapy services is seeking a dynamic individual to lead our Comprehensive Wound Healing Center in Memorial Hermann Baptist Hospital, in Beaumont, TX.


The Program Director is responsible for the leadership within the Comprehensive Wound Healing Center at Memorial Hermann Baptist Beaumont. The position will provide program development, direction to all unit personnel, daily operations supervision, marketing of Center services, and ensuring delivery of Quality Care. The Program Director is accountable for the growth of the center both in terms of patient volumes and revenues, while insuring standards of high quality.


Appropriate candidates will be a Registered Nurse (BSN or higher preferred), currently licensed to practice in the state of Texas. Minimum 3 years operations/marketing/management experience preferred. Current BLS certification is mandatory, ACLS is preferred. Candidates should have strong management experience, preferably working in a multidisciplinary environment. Wound care/hyperbaric experience preferred, however special training provided. Strong communication skills are essential.


Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please fax or email a resume and salary history to:

Don Uhlmeyer @ (281) 298 1570 (FAX)

or duhlmeyer@praxisusa.com

Praxis is an Equal Opportunity Employer.

__________________________________

RN, PROGRAM DIRECTOR,

for Brownsville Surgical Hospital Wound Healing Center

Praxis Clinical Services is a leading national provider of wound care and hyperbaric oxygen therapy services is seeking a dynamic individual to lead our Comprehensive Wound Healing Center at Brownsville Surgical Hospital.


The Program Director is responsible for the leadership within the Comprehensive Wound Healing Center. The position will provide program development, direction to all unit personnel, daily operations supervision, marketing of Center services, and ensuring delivery of Quality Care. The Program Director is accountable for the growth of the center both in terms of patient volumes and revenues, while insuring standards of high quality.


Appropriate candidates will be a Registered Nurse (BSN or higher preferred), currently licensed to practice in the state of Texas. Minimum 3 years operations/marketing/management experience preferred. Current BLS certification is mandatory, ACLS is preferred. Candidates should have strong management experience, preferably working in a multidisciplinary environment. Wound care experience preferred however special training provided. Strong communication skills are essential.


Candidates must be willing to travel for training and occasionally for meetings.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please fax or email a resume and salary history to:

Don Uhlmeyer at duhlmeyer@praxisusa.com

Fax to (281) 298 1570

Praxis is an Equal Opportunity Employer.

___________________________________

RN POSITION

Wound Healing and Hyperbaric Nurse - Per Diem

Tennessee Christian Medical Center

Praxis Clinical Services, Inc.. We are seeking a Per Diem RN with energy, and a willingness to learn new skills, for our Wound Healing and Hyperbaric Unit at Tennessee Christian Medical Center in Madison, TN. This RN must be actively licensed in nursing in the state of Tennessee. This individual must be able to communicate effectively in a multidisciplinary environment.

Job Description:

· The RN must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit as described in unit-based competencies, policies and procedures.

· The RN delegates and collaborates with other staff members.

· Demonstrates critical thinking and independent decision making; utilizing policies and procedures, standards of care and data analysis. (e.g., manages crisis prevention and intervention at unit level).

Job Requirements:

· Nursing Degree from an accredited nursing school (BSN preferred).

· Critical Care experience a plus.

· Strong Wound Care experience preferred.

· BLS (Basic life support) certified.

· ACLS strongly recommended.

· Hyperbaric Oxygen Therapy experience preferred.

· Ability to interact with and maintain a respectful, positive and friendly manner with supervisors, co-workers and internal and external customers to include being flexible with work schedules and requests; keeping commitments; keeping others informed of work progress, timetables and issues; addressing problems and issues constructively to find mutually acceptable and practical business solutions.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

Belinda Blair @ 270-689-1216 (Fax) or,

E-Mail bblair@praxisusa.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

_____________________________________

RN POSITION - HYPERBARIC NURSE - Per Diem

St. Josephs Our Lady of Fatima

Praxis Clinical Services, Inc.. We are seeking a Per Diem RN with energy, and a willingness to learn new skills, for our Hyperbaric Unit at St. Josephs Our Lady of Fatima in North Providence, RI. This RN must be actively licensed in nursing in the state of Rhode Island. This individual must be able to communicate effectively in a multidisciplinary environment.

Job Description:

· The RN must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the

patients served on his or her assigned unit as described in unit-based competencies, policies and procedures.

· The RN delegates and collaborates with other staff members.

· Demonstrates critical thinking and independent decision making; utilizing policies and procedures, standards of care

and data analysis. (e.g., manages crisis prevention and intervention at unit level).

Job Requirements:

· Nursing Degree from an accredited nursing school (BSN preferred).

· Critical Care experience a plus.

· Wound Care experience a plus.

· BLS (Basic life support) certified.

· ACLS strongly recommended.

· Hyperbaric Oxygen Therapy experience preferred.

· Ability to interact with and maintain a respectful, positive and friendly manner with supervisors, co-workers and

internal and external customers to include being flexible with work schedules and requests; keeping commitments;

keeping others informed of work progress, timetables and issues; addressing problems and issues constructively to

find mutually acceptable and practical business solutions.

Salary and benefits are commensurate with experience and qualifications. If you are interested in applying, please send a resume and salary history to the following:

Phil Scelfo @ 401-456-3953 or E-Mail Pscelfo@saintjosephri.com

Thank you for your interest in Praxis Clinical Services.

Praxis is an Equal Opportunity Employer.

____________________________________

FOR MORE CLASSIFIED LISTINGS, VISIT OUR WEBSITE http://www.uhms.org/classifieds.htm

IF YOU HAVE ANY QUESTIONS OR WOULD LIKE TO POST A CLASSIFIED, PLEASE CONTACT ME.

LISA
UHMS

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==> MEETINGS, COURSES AND CONFERENCES <==

The latest news in this area can best be obtained by going to the respective web sites of the agencies involved. These are listed on our web page at http://scuba-doc.com/meetcrse.html .
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==>HUMOR<==
Subject: Touche

A college student challenged a senior citizen, saying it was impossible for their generation to understand his.
"You grew up in a different world," the student said. "Today we have television, jet planes, space travel, nuclear energy, computers..."

Taking advantage of a pause in the student's litany, the geezer said, "You're right. We didn't have those things when we were young; so we invented them! What are you doing for the next generation??"
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Subject: Single

A woman was shopping at her local supermarket where she selected:

* a half-gallon of 2% milk
* a carton of eggs
* a quart of orange juice
* a head of romaine lettuce
* a 2 lb. can of coffee
* a 1 lb. package of bacon

She was unloading her items on the conveyor belt to check out.

A drunk standing behind her watched as she placed the items in front of the cashier.

While the cashier was ringing up her purchases, the drunk calmly stated,"You must be single."

The woman was a bit startled by this proclamation, but she was intrigued by the derelict's intuition, since she was indeed single. She looked at her six items on the belt and saw nothing particularly unusual about her selections that could have tipped off the drunk to her marital status.

Curiosity getting the better of her, she said "Well, you know what, you're absolutely correct. But how on earth did you know that?"

The drunk replied:

"Cause you're ugly."
********************************************************************************
This one has been told before --- but still good the second time around!

Linda Burnett, 23, a resident of San Diego, was visiting her in-laws and while there went to a nearby supermarket to pick up some groceries Several people noticed her setting in the car with the windows rolled up and her eyes closed, with both hands behind the back of her head.

One customer who had been in the store for a while became concerned and walked over to the car. He noticed that Linda's eyes were now open and she looked very strange.

He asked her if she was OK, and Linda replied she'd been shot in the back of the head and had been holding her brains in for over and hour.

The man called the paramedics, who broke into the car because her doors were locked and Linda refused to remove her hands from her head.

When they finally got in, they found that Linda had a wad of bread dough on the back of her head, The Pillsbury biscuit canister had exploded from the heat, making a loud noise that sounded like a gunshot, and the wad of dough hit her in the back of the head.

When she reached back to find out what it was, she felt the dough and thought it was her brains.

She initially passed out, but quickly recovered and tried to hold her brains in for over an hour until someone noticed and came to her aid.

Linda is a blonde, but I'm certain that's not relevant.
***********************************************
A MALE BLONDE JOKE
A BLONDE GUY GETS HOME EARLY FROM WORK AND HEARS STRANGE NOISES COMING FROM THE BEDROOM. HE RUSHES UPSTAIRS TO FIND HIS WIFE NAKED ON THE BED, SWEATING AND PANTING.
"WHAT'S UP?" HE SAYS. "I'M HAVING A HEART ATTACK," CRIES THE WOMAN.
HE RUSHES DOWNSTAIRS TO GRAB THE PHONE, BUT JUST AS HE'S DIALING, HIS
4-YEAR-OLD SON COMES UP AND SAYS "DADDY! DADDY! UNCLE TED'S HIDING IN YOUR CLOSET AND HE'S GOT NO CLOTHES ON!"
THE GUY SLAMS THE PHONE DOWN AND STORMS UPSTAIRS INTO THE BEDROOM, PAST HIS SCREAMING WIFE, AND RIPS OPEN THE WARDROBE DOOR. SURE ENOUGH, THERE IS HIS BROTHER, TOTALLY NAKED, COWERING ON THE CLOSET FLOOR.
"YOU ROTTEN SOB," SAYS THE HUSBAND, "MY WIFE'S HAVING A HEART ATTACK AND YOU'RE RUNNING AROUND NAKED SCARING THE KIDS!"
*************************************************
Zen from Glen
Nuggets of Zen

Do not walk behind me, for I may not lead. Do not
walk ahead of me, for I may not follow. Do not walk
beside me, either. Just leave me the hell alone.


Sex is like air. It's not important unless you
aren't getting any.


If you lend someone $20, and never see that person
again, it was probably worth it.


Give a man a fish and he will eat for a day. Teach
him how to fish, and he will sit in a boat & drink beer all day.


If at first you don't succeed, skydiving is not for you.


Before you criticize someone, you should walk a
mile in their shoes. That way, when you criticize
them, you're a mile away and you have their shoes.


If you think nobody cares if you're alive, try
missing a couple of car payments.


It is far more impressive when others discover your
good qualities without your help.


It may be that your sole purpose in life is simply
to serve as a warning to others.


Never test the depth of the water with both feet.


Always remember you're unique.
Just like everyone else.


No one is listening until you make a mistake.


Don't be irreplaceable. If you can't be replaced,
you can't be promoted.


It's always darkest before dawn. So if you're going
to steal your neighbor's newspaper, that's the time to
do it.


The journey of a thousand miles begins with a broken
fan belt and a leaky tire.

***************************************
Subject: The Drunk Man

A drunken man walks into a biker bar, sits down at the bar and orders a drink. Looking around, he sees 3 men sitting at a corner table. He gets up, staggers to the table, leans over, looks the biggest, meanest, biker in the face and says: "I went by your grandma's house today and I saw
her in the hallway buck-ass naked. Man, she is one fine looking woman!"
The biker looks at him and doesn't say a word. His buddies are confused, because he is one bad biker and would fight at the drop of a hat.
The drunk leans on the table again and says: "I got it on with your grandma and she is good, the best I ever had!"
The biker's buddies are starting to get really mad but the biker still says nothing.
The drunk leans on the table one mor e time and says, "I'll tell you something else, boy, your grandma liked it!"
At this point the biker stands up, takes the drunk by the shoulders looks him square in the eyes and says.... "Grandpa, go home, you're drunk ."
******************************************************
Something of Value!

Sally was driving home from one of her business trips in Northern
Arizona when she saw an elderly Navajo woman walking on the side of
the road.

As the trip was a long and quiet one, she stopped the car and asked
the Navajo woman if she would like a ride.

With a word or two of thanks, she got in the car.

After resuming the journey and a bit of small talk, the Navajo woman
noticed a brown bag on the seat next to Sally.

"What's in the bag?" asked the old woman.

Sally looked down at the brown bag and said, "It's a bottle of wine.
Got it for my husband."

The Navajo woman was silent for a moment, and then speaking with the
quiet wisdom of an elder said, "Good trade"
*****************************************************
==> Dr. Snakebelly's Poetry <==

haiku 1

with wide cavern mouth

a grouper seems hypnotized

by a tiny shrimp


haiku 2

shiny goldblack silk

eel slithers thru coral doors

--- life in the ocean


haiku 3

the cold wind finds me

old snow monkey shivering

just after a dive


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We wish you health, happiness and golden days for 2005!

Enjoy!

scubadoc